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Héroux ME, Fisher G, Axelson LH, Butler AA, Gandevia SC. How we perceive the width of grasped objects: Insights into the central processes that govern proprioceptive judgements. J Physiol 2024. [PMID: 38734987 DOI: 10.1113/jp286322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/09/2024] [Indexed: 05/13/2024] Open
Abstract
Low-level proprioceptive judgements involve a single frame of reference, whereas high-level proprioceptive judgements are made across different frames of reference. The present study systematically compared low-level (grasp → $\rightarrow$ grasp) and high-level (vision → $\rightarrow$ grasp, grasp → $\rightarrow$ vision) proprioceptive tasks, and quantified the consistency of grasp → $\rightarrow$ vision and possible reciprocal nature of related high-level proprioceptive tasks. Experiment 1 (n = 30) compared performance across vision → $\rightarrow$ grasp, a grasp → $\rightarrow$ vision and a grasp → $\rightarrow$ grasp tasks. Experiment 2 (n = 30) compared performance on the grasp → $\rightarrow$ vision task between hands and over time. Participants were accurate (mean absolute error 0.27 cm [0.20 to 0.34]; mean [95% CI]) and precise (R 2 $R^2$ = 0.95 [0.93 to 0.96]) for grasp → $\rightarrow$ grasp judgements, with a strong correlation between outcomes (r = -0.85 [-0.93 to -0.70]). Accuracy and precision decreased in the two high-level tasks (R 2 $R^2$ = 0.86 and 0.89; mean absolute error = 1.34 and 1.41 cm), with most participants overestimating perceived width for the vision → $\rightarrow$ grasp task and underestimating it for grasp → $\rightarrow$ vision task. There was minimal correlation between accuracy and precision for these two tasks. Converging evidence indicated performance was largely reciprocal (inverse) between the vision → $\rightarrow$ grasp and grasp → $\rightarrow$ vision tasks. Performance on the grasp → $\rightarrow$ vision task was consistent between dominant and non-dominant hands, and across repeated sessions a day or week apart. Overall, there are fundamental differences between low- and high-level proprioceptive judgements that reflect fundamental differences in the cortical processes that underpin these perceptions. Moreover, the central transformations that govern high-level proprioceptive judgements of grasp are personalised, stable and reciprocal for reciprocal tasks. KEY POINTS: Low-level proprioceptive judgements involve a single frame of reference (e.g. indicating the width of a grasped object by selecting from a series of objects of different width), whereas high-level proprioceptive judgements are made across different frames of reference (e.g. indicating the width of a grasped object by selecting from a series of visible lines of different length). We highlight fundamental differences in the precision and accuracy of low- and high-level proprioceptive judgements. We provide converging evidence that the neural transformations between frames of reference that govern high-level proprioceptive judgements of grasp are personalised, stable and reciprocal for reciprocal tasks. This stability is likely key to precise judgements and accurate predictions in high-level proprioception.
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Affiliation(s)
- Martin E Héroux
- Neuroscience Research Australia, Randwick, Australia
- University of New South Wales, Sydney, Australia
| | - Georgia Fisher
- Neuroscience Research Australia, Randwick, Australia
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, Australia
| | | | - Annie A Butler
- Neuroscience Research Australia, Randwick, Australia
- University of New South Wales, Sydney, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Randwick, Australia
- University of New South Wales, Sydney, Australia
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Hudson AL, Luu BL, Gandevia SC, Butler JE. Graded onset of parasternal intercostal inspiratory activity detected with surface electromyography in healthy young females and males. J Appl Physiol (1985) 2024; 136:695-706. [PMID: 38328820 DOI: 10.1152/japplphysiol.00604.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/05/2024] [Indexed: 02/09/2024] Open
Abstract
Intramuscular recordings of single motor unit activity from parasternal intercostal muscles show a rostrocaudal gradient in timing and amplitude of inspiratory activity. This study determined the feasibility of surface electromyographic activity (EMG) to measure graded parasternal intercostal activity in young females and males during quiet breathing and breathing with inspiratory resistive loads. Surface EMGs were recorded from the 1st-to-5th parasternal intercostal muscles during 10 min of breathing. EMGs were processed to remove 50 Hz and electrocardiogram artifacts and integrated. Amplitude and onset time of inspiratory activity were measured from waveform averages triggered at the onset of inspiratory flow. Onset times were measured independently by two assessors, blinded to interspace and EMG scale, with excellent agreement (ICC3,k = 0.86). The onset of inspiratory activity in the 1st-to-3rd interspaces was at or within ∼400 ms of the start of inspiratory airflow, but activity in the caudal (4th and 5th) spaces was delayed by up to ∼1,000 ms (P < 0.001). There was no main effect of sex on onset time (P = 0.07), but an interaction with interspace (P < 0.001) revealed that inspiratory activity in the caudal interspaces was delayed by 15% of inspiratory time in female participants compared with 30% of inspiratory time in male participants. Inspiratory loads did not affect EMG onset time (P = 0.31). Thus, surface EMG is feasible to assess the onset time of inspiratory activity as a marker of inspiratory neural drive and pattern of activation across spaces, in both females and males.NEW & NOTEWORTHY We demonstrated that surface EMG is a valid method to measure graded inspiratory EMG in the parasternal intercostal muscles in healthy young male and female participants during quiet breathing and loaded breathing. Across the 1st-to-5th interspaces, there was more homogenous activation in women and more graded activity in men across parasternal intercostal muscles during breathing. By recording surface EMG from both male and female participants, we have revealed sex differences in inspiratory activity across intercostal muscles.
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Affiliation(s)
- Anna L Hudson
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Billy L Luu
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Jane E Butler
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
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Héroux ME, Gandevia SC. Proprioception: Clarification of low-level and high-level-Response to Wali and Block 2024. J Appl Physiol (1985) 2024; 136:511-513. [PMID: 38423517 DOI: 10.1152/japplphysiol.00088.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Affiliation(s)
- Martin E Héroux
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Biomedical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Amann M, Sidhu SK, McNeil CJ, Gandevia SC. Transcranial direct current stimulation to enhance athletic performance: Are we there yet? Will we ever get there? J Physiol 2023; 601:5457-5458. [PMID: 37929747 DOI: 10.1113/jp285691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023] Open
Affiliation(s)
- Markus Amann
- Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA
| | - Simranjit K Sidhu
- School of Biomedicine, University of Adelaide, South Australia, Australia
| | - Chris J McNeil
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Simon C Gandevia
- Neuroscience Research Australia and University of New South Wales, Sydney, Australia
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Jugé L, Liao A, Yeung J, Knapman FL, Bull C, Burke PG, Brown EC, Gandevia SC, Eckert DJ, Butler JE, Bilston LE. Regional associations between inspiratory tongue dilatory movement and genioglossus activity during wakefulness in people with obstructive sleep apnoea. J Physiol 2023; 601:5795-5811. [PMID: 37983193 PMCID: PMC10953361 DOI: 10.1113/jp285187] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/20/2023] [Indexed: 11/22/2023] Open
Abstract
Inspiratory tongue dilatory movement is believed to be mediated via changes in neural drive to genioglossus. However, this has not been studied during quiet breathing in humans. Therefore, this study investigated this relationship and its potential role in obstructive sleep apnoea (OSA). During awake supine quiet nasal breathing, inspiratory tongue dilatory movement, quantified with tagged magnetic resonance imaging, and inspiratory phasic genioglossus EMG normalised to maximum EMG were measured in nine controls [apnoea-hypopnea index (AHI) ≤5 events/h] and 37 people with untreated OSA (AHI >5 events/h). Measurements were obtained for 156 neuromuscular compartments (85%). Analysis was adjusted for nadir epiglottic pressure during inspiration. Only for 106 compartments (68%) was a larger anterior (dilatory) movement associated with a higher phasic EMG [mixed linear regression, beta = 0.089, 95% CI [0.000, 0.178], t(99) = 1.995, P = 0.049, hereafter EMG↗/mvt↗]. For the remaining 50 (32%) compartments, a larger dilatory movement was associated with a lower phasic EMG [mixed linear regression, beta = -0.123, 95% CI [-0.224, -0.022], t(43) = -2.458, P = 0.018, hereafter EMG↘/mvt↗]. OSA participants had a higher odds of having at least one decoupled EMG↘/mvt↗ compartment (binary logistic regression, odds ratio [95% CI]: 7.53 [1.19, 47.47] (P = 0.032). Dilatory tongue movement was minimal (>1 mm) in nearly all participants with only EMG↗/mvt↗ compartments (86%, 18/21). These results demonstrate that upper airway dilatory mechanics cannot be predicted from genioglossus EMG, particularly in people with OSA. Tongue movement associated with minimal genioglossus activity suggests co-activation of other airway dilator muscles. KEY POINTS: Inspiratory tongue movement is thought to be mediated through changes in genioglossus activity. However, it is unknown if this relationship is altered by obstructive sleep apnoea (OSA). During awake supine quiet nasal breathing, inspiratory tongue movement, quantified with tagged magnetic resonance imaging (MRI), and inspiratory phasic genioglossus EMG normalised to maximum EMG were measured in four tongue compartments of people with and without OSA. Larger tongue anterior (dilatory) movement was associated with higher phasic genioglossus EMG for 68% of compartments. OSA participants had an ∼7-times higher odds of having at least one compartment for which a larger anterior tongue movement was not associated with a higher phasic EMG than controls. Therefore, higher genioglossus phasic EMG does not consistently translate into tongue dilatory movement, particularly in people with OSA. Large dilatory tongue movements can occur despite minimal genioglossus inspiratory activity, suggesting co-activation of other pharyngeal muscles.
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Affiliation(s)
- Lauriane Jugé
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Angela Liao
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Jade Yeung
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
| | - Fiona L. Knapman
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Christopher Bull
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Peter G.R. Burke
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
- Macquarie Medical SchoolFaculty of Medicine and Health SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Elizabeth C. Brown
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
- Prince of Wales HospitalSydneyNew South WalesAustralia
| | - Simon C. Gandevia
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Danny J. Eckert
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
- Adelaide Institute for Sleep Health and Flinders Health and Medical Research InstituteFlinders UniversityAdelaideAustralia
| | - Jane E. Butler
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Lynne E. Bilston
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
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Luu BL, Lewis RHC, McBain RA, Gandevia SC, Boswell-Ruys CL, Butler JE. Effect of respiratory muscle training on load sensations in people with chronic tetraplegia: a secondary analysis of a randomised controlled trial. Spinal Cord 2023; 61:505-512. [PMID: 37587377 PMCID: PMC10495260 DOI: 10.1038/s41393-023-00920-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 07/12/2023] [Accepted: 07/19/2023] [Indexed: 08/18/2023]
Abstract
STUDY DESIGN Secondary analysis of a randomised controlled trial. OBJECTIVES Our primary study showed that increasing inspiratory muscle strength with training in people with chronic (>1 year) tetraplegia corresponded with reduced sensations of breathlessness when inspiration was loaded. This study investigated whether respiratory muscle training also affected the respiratory sensations for load detection and magnitude perception. SETTING Independent research institute in Sydney, Australia. METHODS Thirty-two adults with chronic tetraplegia participated in a 6-week, supervised training protocol. The active group trained the inspiratory muscles through progressive threshold loading. The sham group performed the same protocol with a fixed threshold load (3.6 cmH2O). Primary measures were load detection threshold and perceived magnitudes of six suprathreshold loads reported using the modified Borg scale. RESULTS Maximal inspiratory pressure (PImax) increased by 32% (95% CI, 18-45) in the active group with no change in the sham group (p = 0.51). The training intervention did not affect detection thresholds in the active (p = 0.24) or sham (p = 0.77) group, with similar overall decreases in Borg rating of 0.83 (95% CI, 0.49-1.17) in active and 0.72 (95% CI, 0.32-1.12) in sham group. Increased inspiratory muscle strength reduced slope magnitude between Borg rating and peak inspiratory pressure (p = 0.003), but not when pressure was divided by PImax to reflect contraction intensity (p = 0.92). CONCLUSIONS Training reduces the sensitivity of load sensations for a given change in pressure but not for a given change in contraction intensity.
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Affiliation(s)
- Billy L Luu
- Spinal Cord Injury Research Centre, Neuroscience Research Australia, Randwick, NSW, Australia
| | - R H Chaminda Lewis
- Spinal Cord Injury Research Centre, Neuroscience Research Australia, Randwick, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
- Prince of Wales Hospital, Randwick, NSW, Australia
| | - Rachel A McBain
- Spinal Cord Injury Research Centre, Neuroscience Research Australia, Randwick, NSW, Australia
| | - Simon C Gandevia
- Spinal Cord Injury Research Centre, Neuroscience Research Australia, Randwick, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
- Prince of Wales Hospital, Randwick, NSW, Australia
| | - Claire L Boswell-Ruys
- Spinal Cord Injury Research Centre, Neuroscience Research Australia, Randwick, NSW, Australia.
- University of New South Wales, Sydney, NSW, Australia.
- Prince of Wales Hospital, Randwick, NSW, Australia.
| | - Jane E Butler
- Spinal Cord Injury Research Centre, Neuroscience Research Australia, Randwick, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
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Finn HT, Bye EA, Elphick TG, Boswell-Ruys CL, Gandevia SC, Butler JE, Héroux ME. Transcutaneous spinal stimulation in people with and without spinal cord injury: Effect of electrode placement and trains of stimulation on threshold intensity. Physiol Rep 2023; 11:e15692. [PMID: 37269156 PMCID: PMC10238786 DOI: 10.14814/phy2.15692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/03/2023] [Indexed: 06/04/2023] Open
Abstract
Transcutaneous spinal cord stimulation (TSS) is purported to improve motor function in people after spinal cord injury (SCI). However, several methodology aspects are yet to be explored. We investigated whether stimulation configuration affected the intensity needed to elicit spinally evoked motor responses (sEMR) in four lower limb muscles bilaterally. Also, since stimulation intensity for therapeutic TSS (i.e., trains of stimulation, typically delivered at 15-50 Hz) is sometimes based on the single-pulse threshold intensity, we compared these two stimulation types. In non-SCI participants (n = 9) and participants with a SCI (n = 9), three different electrode configurations (cathode-anode); L1-midline (below the umbilicus), T11-midline and L1-ASIS (anterior superior iliac spine; non-SCI only) were compared for the sEMR threshold intensity using single pulses or trains of stimulation which were recorded in the vastus medialis, medial hamstring, tibialis anterior, medial gastrocnemius muscles. In non-SCI participants, the L1-midline configuration showed lower sEMR thresholds compared to T11-midline (p = 0.002) and L1-ASIS (p < 0.001). There was no difference between T11-midline and L1-midline for participants with SCI (p = 0.245). Spinally evoked motor response thresholds were ~13% lower during trains of stimulation compared to single pulses in non-SCI participants (p < 0.001), but not in participants with SCI (p = 0.101). With trains of stimulation, threshold intensities were slightly lower and the incidence of sEMR was considerably lower. Overall, stimulation threshold intensities were generally lower with the L1-midline electrode configuration and is therefore preferred. While single-pulse threshold intensities may overestimate threshold intensities for therapeutic TSS, tolerance to trains of stimulation will be the limiting factor in most cases.
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Affiliation(s)
- Harrison T Finn
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Biomedical Sciences, University of New South Wales, New South Wales, Kensington, Australia
| | - Elizabeth A Bye
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Biomedical Sciences, University of New South Wales, New South Wales, Kensington, Australia
- Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Thomas G Elphick
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Biomedical Sciences, University of New South Wales, New South Wales, Kensington, Australia
| | - Claire L Boswell-Ruys
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Biomedical Sciences, University of New South Wales, New South Wales, Kensington, Australia
- Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- Prince of Wales Hospital, Randwick, New South Wales, Australia
- School of Clinical Medicine, University of New South Wales, New South Wales, Kensington, Australia
| | - Jane E Butler
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Biomedical Sciences, University of New South Wales, New South Wales, Kensington, Australia
| | - Martin E Héroux
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Biomedical Sciences, University of New South Wales, New South Wales, Kensington, Australia
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Ingram LA, Butler AA, Lord SR, Gandevia SC. Use of a physiological profile to document upper limb motor impairment in ageing and in neurological conditions. J Physiol 2023; 601:2251-2262. [PMID: 36271625 PMCID: PMC10952577 DOI: 10.1113/jp283703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/06/2022] [Indexed: 11/08/2022] Open
Abstract
Profiling performance in the physiological domains underpinning upper limb function (such as strength, sensation, coordination) provides insight into an individual's specific impairments. This compliments the traditional medical 'diagnosis' model that is currently used in contemporary medicine. From an initial battery of 13 tests in which data were collected across the adult lifespan (n = 367, 20-95 years) and in those with neurological conditions (specifically, multiple sclerosis (n = 40), Parkinson's disease (n = 34), and stroke (n = 50)), six tests were selected to comprise a core upper limb physiological profile assessment (PPA). This comprised measures of handgrip strength, simple reaction time, finger dexterity, tactile sensation, bimanual coordination, and a functional task. Individual performance in each of these tests can be compared to a reference population score (devised from our database of healthy individuals aged under 60 years), informing the researcher or clinician how to best direct an intervention or treatment for the individual based on their specific impairment(s). Lastly, a composite score calculated from the average performance across the six tests provides a broad overview of an individual's overall upper limb function. Collectively, the upper limb PPA highlights specific impairments that are prevalent within distinct pathologies and reveals the magnitude of upper limb motor impairment specific to each condition.
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Affiliation(s)
- Lewis A. Ingram
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
- University of South AustraliaAdelaideSouth AustraliaAustralia
| | - Annie A. Butler
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
- University of New South WalesSydneyNew South WalesAustralia
| | - Stephen R. Lord
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
- University of New South WalesSydneyNew South WalesAustralia
| | - Simon C. Gandevia
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
- University of New South WalesSydneyNew South WalesAustralia
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Todd G, Rae CD, Taylor JL, Rogasch NC, Butler JE, Hayes M, Wilcox RA, Gandevia SC, Aoun K, Esterman A, Lewis SJG, Hall JM, Matar E, Godau J, Berg D, Plewnia C, von Thaler A, Chiang C, Double KL. Motor cortical excitability and pre-supplementary motor area neurochemistry in healthy adults with substantia nigra hyperechogenicity. J Neurosci Res 2023; 101:263-277. [PMID: 36353842 PMCID: PMC10952673 DOI: 10.1002/jnr.25145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 10/08/2022] [Accepted: 10/26/2022] [Indexed: 11/12/2022]
Abstract
Substantia nigra (SN) hyperechogenicity, viewed with transcranial ultrasound, is a risk marker for Parkinson's disease. We hypothesized that SN hyperechogenicity in healthy adults aged 50-70 years is associated with reduced short-interval intracortical inhibition in primary motor cortex, and that the reduced intracortical inhibition is associated with neurochemical markers of activity in the pre-supplementary motor area (pre-SMA). Short-interval intracortical inhibition and intracortical facilitation in primary motor cortex was assessed with paired-pulse transcranial magnetic stimulation in 23 healthy adults with normal (n = 14; 61 ± 7 yrs) or abnormally enlarged (hyperechogenic; n = 9; 60 ± 6 yrs) area of SN echogenicity. Thirteen of these participants (7 SN- and 6 SN+) also underwent brain magnetic resonance spectroscopy to investigate pre-SMA neurochemistry. There was no relationship between area of SN echogenicity and short-interval intracortical inhibition in the ipsilateral primary motor cortex. There was a significant positive relationship, however, between area of echogenicity in the right SN and the magnitude of intracortical facilitation in the right (ipsilateral) primary motor cortex (p = .005; multivariate regression), evidenced by the amplitude of the conditioned motor evoked potential (MEP) at the 10-12 ms interstimulus interval. This relationship was not present on the left side. Pre-SMA glutamate did not predict primary motor cortex inhibition or facilitation. The results suggest that SN hyperechogenicity in healthy older adults may be associated with changes in excitability of motor cortical circuitry. The results advance understanding of brain changes in healthy older adults at risk of Parkinson's disease.
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Affiliation(s)
- Gabrielle Todd
- UniSA Clinical & Health Sciences and Alliance for Research in Exercise, Nutrition and Activity (ARENA)University of South AustraliaAdelaideSouth AustraliaAustralia
| | - Caroline D. Rae
- Neuroscience Research AustraliaRandwickNew South WalesAustralia
- Faculty of MedicineUniversity of New South WalesKensingtonNew South WalesAustralia
| | - Janet L. Taylor
- Neuroscience Research AustraliaRandwickNew South WalesAustralia
- Faculty of MedicineUniversity of New South WalesKensingtonNew South WalesAustralia
- School of Medical and Health SciencesEdith Cowan UniversityJoondalupWestern AustraliaAustralia
| | - Nigel C. Rogasch
- Hopwood Centre for NeurobiologySouth Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
- Faculty of Health and Medical SciencesThe University of AdelaideAdelaideSouth AustraliaAustralia
- School of Psychological Sciences and Turner Institute for Brain and Mental HealthMonash UniversityMelbourneVictoriaAustralia
| | - Jane E. Butler
- Neuroscience Research AustraliaRandwickNew South WalesAustralia
- Faculty of MedicineUniversity of New South WalesKensingtonNew South WalesAustralia
| | - Michael Hayes
- Department of NeurologyConcord Repatriation General HospitalConcordNew South WalesAustralia
| | - Robert A. Wilcox
- UniSA Clinical & Health Sciences and Alliance for Research in Exercise, Nutrition and Activity (ARENA)University of South AustraliaAdelaideSouth AustraliaAustralia
- Department of NeurologyFlinders Medical CentreBedford ParkSouth AustraliaAustralia
- College of Medicine and Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Simon C. Gandevia
- Neuroscience Research AustraliaRandwickNew South WalesAustralia
- Faculty of MedicineUniversity of New South WalesKensingtonNew South WalesAustralia
| | - Karl Aoun
- Brain and Mind Centre and School of Medical Sciences (Neuroscience)The University of SydneySydneyNew South WalesAustralia
| | - Adrian Esterman
- UniSA Clinical & Health Sciences and Alliance for Research in Exercise, Nutrition and Activity (ARENA)University of South AustraliaAdelaideSouth AustraliaAustralia
| | - Simon J. G. Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, Faculty of Medicine and HealthThe University of SydneyCamperdownNew South WalesAustralia
| | - Julie M. Hall
- Department of Experimental PsychologyGhent UniversityGhentBelgium
| | - Elie Matar
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, Faculty of Medicine and HealthThe University of SydneyCamperdownNew South WalesAustralia
| | - Jana Godau
- Department of NeurologyKlinikum Kassel GmbHKasselGermany
| | - Daniela Berg
- Department of Neurology, UKSH, Campus KielChristian‐Albrechts‐UniversityKielGermany
| | - Christian Plewnia
- Department of Psychiatry and Psychotherapy, Neurophysiology & Interventional NeuropsychiatryUniversity of TübingenTübingenGermany
| | | | - Clarence Chiang
- Neuroscience Research AustraliaRandwickNew South WalesAustralia
- Faculty of MedicineUniversity of New South WalesKensingtonNew South WalesAustralia
| | - Kay L. Double
- Neuroscience Research AustraliaRandwickNew South WalesAustralia
- Brain and Mind Centre and School of Medical Sciences (Neuroscience)The University of SydneySydneyNew South WalesAustralia
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Diong J, Bye E, Djajadikarta Z, Butler AA, Gandevia SC, Héroux ME. Encouraging responsible reporting practices in the Instructions to Authors of neuroscience and physiology journals: There is room to improve. PLoS One 2023; 18:e0283753. [PMID: 36996120 PMCID: PMC10062619 DOI: 10.1371/journal.pone.0283753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/16/2023] [Indexed: 03/31/2023] Open
Abstract
Journals can substantially influence the quality of research reports by including responsible reporting practices in their Instructions to Authors. We assessed the extent to which 100 journals in neuroscience and physiology required authors to report methods and results in a rigorous and transparent way. For each journal, Instructions to Authors and any referenced reporting guideline or checklist were downloaded from journal websites. Twenty-two questions were developed to assess how journal Instructions to Authors address fundamental aspects of rigor and transparency in five key reporting areas. Journal Instructions to Authors and all referenced external guidelines and checklists were audited against these 22 questions. Of the full sample of 100 Instructions to Authors, 34 did not reference any external reporting guideline or checklist. Reporting whether clinical trial protocols were pre-registered was required by 49 journals and encouraged by 7 others. Making data publicly available was encouraged by 64 journals; making (processing or statistical) code publicly available was encouraged by ∼30 of the journals. Other responsible reporting practices were mentioned by less than 20 of the journals. Journals can improve the quality of research reports by mandating, or at least encouraging, the responsible reporting practices highlighted here.
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Affiliation(s)
- Joanna Diong
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia
| | - Elizabeth Bye
- Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | | | - Annie A Butler
- Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia
- Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Martin E Héroux
- Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
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11
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Epiu I, Gandevia SC, Boswell‐Ruys CL, Carter SG, Finn HT, Nguyen DAT, Butler JE, Hudson AL. Respiratory-related evoked potentials in chronic obstructive pulmonary disease and healthy aging. Physiol Rep 2022; 10:e15519. [PMID: 36461659 PMCID: PMC9718949 DOI: 10.14814/phy2.15519] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 06/17/2023] Open
Abstract
Altered neural processing and increased respiratory sensations have been reported in chronic obstructive pulmonary disease (COPD) as larger respiratory-related evoked potentials (RREPs), but the effect of healthy-aging has not been considered adequately. We tested RREPs evoked by brief airway occlusions in 10 participants with moderate-to-severe COPD, 11 age-matched controls (AMC) and 14 young controls (YC), with similar airway occlusion pressure stimuli across groups. Mean age was 76 years for COPD and AMC groups, and 30 years for the YC group. Occlusion intensity and unpleasantness was rated using the modified Borg scale, and anxiety rated using the Hospital Anxiety and Depression Scale. There was no difference in RREP peak amplitudes across groups, except for the N1 peak, which was significantly greater in the YC group than the COPD and AMC groups (p = 0.011). The latencies of P1, P2 and P3 occurred later in COPD versus YC (p < 0.05). P3 latency occurred later in AMC than YC (p = 0.024). COPD and AMC groups had similar Borg ratings for occlusion intensity (3.0 (0.5, 3.5) [Median (IQR)] and 3.0 (3.0, 3.0), respectively; p = 0.476) and occlusion unpleasantness (1.3 (0.1, 3.4) and 1.0 (0.75, 2.0), respectively; p = 0.702). The COPD group had a higher anxiety score than AMC group (p = 0.013). A higher N1 amplitude suggests the YC group had higher cognitive processing of respiratory inputs than the COPD and AMC groups. Both COPD and AMC groups showed delayed neural responses to the airway occlusion, which may indicate impaired processing of respiratory sensory inputs in COPD and healthy aging.
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Affiliation(s)
- Isabella Epiu
- Neuroscience Research AustraliaRandwickNew South WalesAustralia
- University of New South WalesSydneyNew South WalesAustralia
- Prince of Wales HospitalSydneyNew South WalesAustralia
| | - Simon C. Gandevia
- Neuroscience Research AustraliaRandwickNew South WalesAustralia
- University of New South WalesSydneyNew South WalesAustralia
- Prince of Wales HospitalSydneyNew South WalesAustralia
| | - Claire L. Boswell‐Ruys
- Neuroscience Research AustraliaRandwickNew South WalesAustralia
- University of New South WalesSydneyNew South WalesAustralia
- Prince of Wales HospitalSydneyNew South WalesAustralia
| | - Sophie G. Carter
- Neuroscience Research AustraliaRandwickNew South WalesAustralia
- University of New South WalesSydneyNew South WalesAustralia
| | - Harrison T. Finn
- Neuroscience Research AustraliaRandwickNew South WalesAustralia
- University of New South WalesSydneyNew South WalesAustralia
| | - David A. T. Nguyen
- Neuroscience Research AustraliaRandwickNew South WalesAustralia
- University of New South WalesSydneyNew South WalesAustralia
| | - Jane E. Butler
- Neuroscience Research AustraliaRandwickNew South WalesAustralia
- University of New South WalesSydneyNew South WalesAustralia
| | - Anna L. Hudson
- Neuroscience Research AustraliaRandwickNew South WalesAustralia
- University of New South WalesSydneyNew South WalesAustralia
- College of Medicine and Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
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12
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Amann M, Sidhu SK, McNeil CJ, Gandevia SC. Critical considerations of the contribution of the corticomotoneuronal pathway to central fatigue. J Physiol 2022; 600:5203-5214. [PMID: 36326193 PMCID: PMC9772161 DOI: 10.1113/jp282564] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
Abstract
Neural drive originating in higher brain areas reaches exercising limb muscles through the corticospinal-motoneuronal pathway, which links the motor cortex and spinal motoneurones. The properties of this pathway have frequently been observed to change during fatiguing exercise in ways that could influence the development of central fatigue (i.e. the progressive reduction in voluntary muscle activation). However, based on differences in motor cortical and motoneuronal excitability between exercise modalities (e.g. single-joint vs. locomotor exercise), there is no characteristic response that allows for a categorical conclusion about the effect of these changes on functional impairments and performance limitations. Despite the lack of uniformity in findings during fatigue, there is strong evidence for marked 'inhibition' of motoneurones as a direct result of voluntary drive. Endogenous forms of neuromodulation, such as via serotonin released from neurones, can directly affect motoneuronal output and central fatigue. Exogenous forms of neuromodulation, such as brain stimulation, may achieve a similar effect, although the evidence is weak. Non-invasive transcranial direct current stimulation can cause transient or long-lasting changes in cortical excitability; however, variable results across studies cast doubt on its claimed capacity to enhance performance. Furthermore, with these studies, it is difficult to establish a cause-and-effect relationship between brain responsiveness and exercise performance. This review briefly summarizes changes in the corticomotoneuronal pathway during various types of exercise, and considers the relevance of these changes for the development of central fatigue, as well as the potential of non-invasive brain stimulation to enhance motor cortical excitability, motoneuronal output and, ultimately, exercise performance.
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Affiliation(s)
- Markus Amann
- Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA
| | - Simranjit K. Sidhu
- School of Biomedicine, The University of Adelaide, South Australia, Australia
| | - Chris J McNeil
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
| | - Simon C Gandevia
- Neuroscience Research Australia and University of New South Wales, Sydney, Australia
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13
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Allen GM, Palermo AE, McNaughton KMD, Boswell-Ruys CL, Lee BB, Butler JE, Gandevia SC, McCaughey EJ. Effectiveness of Abdominal Functional Electrical Stimulation for Improving Bowel Function in People With a Spinal Cord Injury: A Study Protocol for a Double-Blinded Randomized Placebo-Controlled Clinical Trial. Top Spinal Cord Inj Rehabil 2022; 28:22-31. [PMID: 36457354 PMCID: PMC9678222 DOI: 10.46292/sci22-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background People with a spinal cord injury (SCI) have a high rate of bowel-related morbidity, even compared with people with other neurological disorders. These complications lower quality of life and place a financial burden on the health system. A noninvasive intervention that improves the bowel function of people with an SCI should reduce morbidity, improve quality of life, and lead to cost savings for health care providers. Objectives To investigate the effectiveness of noninvasive abdominal functional electrical stimulation (FES) for improving bowel function in people with a chronic SCI. Methods A prospective, double-blinded, 1:1 randomized, placebo-controlled intervention trial will be conducted with 80 adults with chronic SCI (>12 months since injury) above T8 single neurological level. The intervention will be a 45-minute abdominal FES (or placebo) session, 3 days per week, for 6 weeks. Main Study Parameters/Endpoints Primary endpoint is whole gut transit time before and after 6 weeks of abdominal FES. Secondary endpoints measured before and after 6 weeks of abdominal FES are (1) colonic transit time; (2) quality of life (EQ-5D-5L); (3) participant-reported bowel function (International SCI Bowel Function Basic Data Set Questionnaire and visual analogue scale); (4) respiratory function (forced vital capacity, forced expiratory volume in 1 second, peak expiratory flow, maximal inspiratory pressure, and maximal expiratory pressure); (5) bladder symptoms (Neurogenic Bladder Symptom Score); (6) daily bowel management diary; and (7) unplanned hospital visits. Conclusion Safety data will be collected, and a cost utility analysis using quality of life scores will be performed. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000386831.
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Affiliation(s)
- Gabrielle M Allen
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Medical Sciences, University of New South Wales, Kensington, New South Wales, Australia
| | - Anne E Palermo
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Medical Sciences, University of New South Wales, Kensington, New South Wales, Australia
| | - Keith M D McNaughton
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Medical Sciences, University of New South Wales, Kensington, New South Wales, Australia
| | - Claire L Boswell-Ruys
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Medical Sciences, University of New South Wales, Kensington, New South Wales, Australia
- Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Bonsan B Lee
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Medical Sciences, University of New South Wales, Kensington, New South Wales, Australia
- Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Jane E Butler
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Medical Sciences, University of New South Wales, Kensington, New South Wales, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Medical Sciences, University of New South Wales, Kensington, New South Wales, Australia
- Prince of Wales Clinical School, University of New South Wales, Kensington, Australia
| | - Euan J McCaughey
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Medical Sciences, University of New South Wales, Kensington, New South Wales, Australia
- Queen Elizabeth National Spinal Injuries Unit, Queen Elizabeth University Hospital, Glasgow, Scotland
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14
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Luu BL, Lewis RHC, Gandevia SC, Boswell-Ruys CL, Butler JE. The detection and sensory perception of inspiratory resistive loads in people with chronic tetraplegia. J Appl Physiol (1985) 2022; 133:1192-1201. [PMID: 36107987 DOI: 10.1152/japplphysiol.00064.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
This study investigated sensations of breathing following tetraplegia. Fifteen people with chronic tetraplegia and fifteen healthy able-bodied controls matched for age, sex, height, and weight participated. Sensations of breathing were quantified by determining the threshold for detecting an added resistance during inspiration. In a separate task, the perceived magnitudes of six suprathreshold resistive loads were determined with a modified Borg scale. The detection threshold of 0.34 cmH2O/L/s [standard deviation (SD) 0.14] in the tetraplegia group was higher than the 0.23 cmH2O/L/s (SD 0.10) threshold for able-bodied controls (P = 0.004). Both participant groups perceived larger loads to be more effortful, with the Borg effort rating increasing linearly with the peak inspiratory pressure generated at each load. The relationship between Borg effort rating and peak inspiratory pressure was steeper in participants with tetraplegia than in able-bodied controls (P = 0.001), but there was no difference when pressure was divided by maximal inspiratory pressure (P = 0.95). Despite a higher detection threshold, the findings suggest that the perceived magnitude of a suprathreshold inspiratory load is not impaired in chronic tetraplegia and that load magnitude perception is related to the maximal, and not absolute, inspiratory muscle force.NEW & NOTEWORTHY Sensations of breathing are thought to be impaired following chronic tetraplegia. The detection threshold for an added resistive load during inspiration was higher in people with tetraplegia than in healthy able-bodied participants. However, for inspiratory loads above the detection threshold, the perceived magnitude of a resistive load as a function of the peak inspiratory pressure was greater in tetraplegia. Load magnitude perception was comparable between participant groups when peak pressure was divided by maximal inspiratory pressure.
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Affiliation(s)
- Billy L Luu
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - R H Chaminda Lewis
- Neuroscience Research Australia, Randwick, New South Wales, Australia.,Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Randwick, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia.,Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Claire L Boswell-Ruys
- Neuroscience Research Australia, Randwick, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia.,Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Jane E Butler
- Neuroscience Research Australia, Randwick, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
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15
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Héroux ME, Butler AA, Cashin AG, McCaughey EJ, Affleck AJ, Green MA, Cartwright A, Jones M, Kiely KM, van Schooten KS, Menant JC, Wewege M, Gandevia SC. Quality Output Checklist and Content Assessment (QuOCCA): a new tool for assessing research quality and reproducibility. BMJ Open 2022; 12:e060976. [PMID: 36167369 PMCID: PMC9516158 DOI: 10.1136/bmjopen-2022-060976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Research must be well designed, properly conducted and clearly and transparently reported. Our independent medical research institute wanted a simple, generic tool to assess the quality of the research conducted by its researchers, with the goal of identifying areas that could be improved through targeted educational activities. Unfortunately, none was available, thus we devised our own. Here, we report development of the Quality Output Checklist and Content Assessment (QuOCCA), and its application to publications from our institute's scientists. Following consensus meetings and external review by statistical and methodological experts, 11 items were selected for the final version of the QuOCCA: research transparency (items 1-3), research design and analysis (items 4-6) and research reporting practices (items 7-11). Five pairs of raters assessed all 231 articles published in 2017 and 221 in 2018 by researchers at our institute. Overall, the results were similar between years and revealed limited engagement with several recommended practices highlighted in the QuOCCA. These results will be useful to guide educational initiatives and their effectiveness. The QuOCCA is brief and focuses on broadly applicable and relevant concepts to open, high-quality, reproducible and well-reported science. Thus, the QuOCCA could be used by other biomedical institutions and individual researchers to evaluate research publications, assess changes in research practice over time and guide the discussion about high-quality, open science. Given its generic nature, the QuOCCA may also be useful in other research disciplines.
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Affiliation(s)
- Martin E Héroux
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Annie A Butler
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Aidan G Cashin
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Euan J McCaughey
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- Queen Elizabeth National Spinal Injuries Unit, Queen Elizabeth University Hospital Campus, Glasgow, UK
| | - Andrew J Affleck
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- Department of Neuropathology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Michael A Green
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | | | - Matthew Jones
- University of New South Wales, Sydney, New South Wales, Australia
| | - Kim M Kiely
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Kimberley S van Schooten
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Jasmine C Menant
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Wewege
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
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16
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Héroux ME, Butler AA, Robertson LS, Fisher G, Blouin JS, Diong J, Krewer C, Tremblay F, Gandevia SC. Proprioception: fallacies and misconceptions - response to Han et al. 2022. J Appl Physiol (1985) 2022; 133:608-610. [PMID: 36041481 DOI: 10.1152/japplphysiol.00409.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Martin E Héroux
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Annie A Butler
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Lucy S Robertson
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Georgia Fisher
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Jean-Sébastien Blouin
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joanna Diong
- Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Carmen Krewer
- Schoen Clinic Bad Aibling, Bad Aibling, Germany.,Department of Sports and Health Sciences, Human Movement Science, Technical University Munich, Munich, Germany
| | - François Tremblay
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Simon C Gandevia
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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17
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Carberry JC, Burke PGR, Osman AM, Jugé L, Toson B, Gandevia SC, Butler JE, Bilston LE, Eckert DJ. Regional genioglossus reflex responses to negative pressure pulses in people with obstructive sleep apnea. J Appl Physiol (1985) 2022; 133:755-765. [PMID: 35771222 DOI: 10.1152/japplphysiol.00083.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Tongue and upper airway dilator muscle movement patterns during quiet breathing vary in people with obstructive sleep apnea (OSA). Many patients have inadequate or counterproductive responses to inspiratory negative airway pressure that likely contributes to their OSA. This may be due, at least in part, to inadequate or non-homogeneous reflex drive to different regions of the largest upper airway dilator, genioglossus. To investigate potential regional heterogeneity of genioglossus reflex responses in OSA, brief suction pulses were applied via nasal breathing mask and electromyogram (EMG) was recorded in 4 regions (anterior oblique, anterior horizontal, posterior oblique, posterior horizontal) using intramuscular fine wire electrodes in 15 people with OSA. Genioglossus short-latency reflex excitation amplitude had regional heterogeneity (horizontal vs. oblique regions) when expressed in absolute units but homogeneity when normalized as a percentage of the immediate (100ms) pre-stimulus EMG. Regional variability in reflex morphology (excitation and inhibition) was present in one third of participants. Minimum cross-sectional area (CSA) of the pharyngeal airway quantified using MRI and may be related to the amplitude of the short-latency reflex response to negative pressure such that we found that people with a smaller CSA tended to have greater reflex amplitude (e.g. horizontal region r2=0.41, p=0.01). These findings highlight the complexity of genioglossus reflex control, the potential for regional heterogeneity and the functional importance of upper airway anatomy in mediating genioglossus reflex responses to rapid changes in negative pressure in OSA.
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Affiliation(s)
- Jayne C Carberry
- Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia.,Neuroscience Research Australia, Sydney, New South Wales, Australia.,University College Dublin, School of Medicine, Ireland
| | - Peter George Redmayne Burke
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,UNSW Sydney, Randwick, Australia.,Department of Biomedical Sciences, Macquarie University, Australia
| | - Amal M Osman
- Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia.,Neuroscience Research Australia, Sydney, New South Wales, Australia.,UNSW Sydney, Randwick, Australia
| | - Lauriane Jugé
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,UNSW Sydney, Randwick, Australia
| | - Barbara Toson
- Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,UNSW Sydney, Randwick, Australia
| | - Jane E Butler
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,UNSW Sydney, Randwick, Australia
| | - Lynne E Bilston
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,UNSW Sydney, Randwick, Australia
| | - Danny J Eckert
- Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia.,Neuroscience Research Australia, Sydney, New South Wales, Australia.,UNSW Sydney, Randwick, Australia
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18
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Finn HT, Bogdanovski O, Hudson AL, McCaughey EJ, Crawford MR, Taylor JL, Butler JE, Gandevia SC. The effect of acute intermittent hypoxia on human limb motoneurone output. Exp Physiol 2022; 107:615-630. [PMID: 35338753 DOI: 10.1113/ep090099] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 03/17/2022] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? Does a single session of repeated bouts of acute intermittent hypoxic breathing enhance the motoneuronal output of the limb muscles of healthy able-bodied participants? What is the main finding and its importance? Compared to breathing room air, there were some increases in motoneuronal output following acute intermittent hypoxia, but the increases were variable across participants, in time after the intervention and depended on which neurophysiological measure was checked. ABSTRACT Acute intermittent hypoxia (AIH) induces persistent increases in output from rat phrenic motoneurones. Studies in people with spinal cord injury suggest AIH improves limb performance, perhaps via postsynaptic changes at cortico-motoneuronal synapses. We assessed whether limb motoneurone output in response to reflex and descending synaptic activation is facilitated after one session of AIH in healthy able-bodied volunteers. Fourteen participants completed two experimental days, either AIH or a sham intervention (randomised crossover design). We measured H-reflex recruitment curves and homosynaptic post-activation depression (HPAD) of the H reflex in soleus, and motor evoked potentials (MEPs) evoked by transcranial magnetic stimulation (TMS) and their recruitment curves, in first dorsal interosseous. All measurements were performed at rest and occurred at baseline, 0, 20, 40, and 60 minutes post-intervention. The intervention was 30 minutes of either normoxia (sham, FiO2 ≈ 0.21) or AIH (alternate 1-minute hypoxia [FiO2 ≈ 0.09], 1-minute normoxia). After AIH the H-reflex recruitment curve shifted leftward. Lower stimulation intensities were needed to evoke 5%, 50%, and 99% of the maximal H reflex at 40 and 60 minutes after AIH (P<0.04). The maximal H reflex, recruitment slope and HPAD, were unchanged after AIH. MEPs evoked by constant intensity TMS were larger 40 minutes after AIH (P = 0.027). There was no change in MEP recruitment or the maximal MEP. In conclusion, some measures of the evoked responses from limb motoneurones increased after a single AIH session, but only at discrete time points. It is unclear to what extent these changes alter functional performance. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Harrison T Finn
- Neuroscience Research Australia, Sydney, NSW, 2031, Australia.,University of New South Wales, Sydney, NSW, 2052, Australia
| | - Oliver Bogdanovski
- Neuroscience Research Australia, Sydney, NSW, 2031, Australia.,University of New South Wales, Sydney, NSW, 2052, Australia
| | - Anna L Hudson
- Neuroscience Research Australia, Sydney, NSW, 2031, Australia.,University of New South Wales, Sydney, NSW, 2052, Australia.,College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - Euan J McCaughey
- Neuroscience Research Australia, Sydney, NSW, 2031, Australia.,University of New South Wales, Sydney, NSW, 2052, Australia
| | | | - Janet L Taylor
- Neuroscience Research Australia, Sydney, NSW, 2031, Australia.,Edith Cowan University, Perth, WA, 6027, Australia
| | - Jane E Butler
- Neuroscience Research Australia, Sydney, NSW, 2031, Australia.,University of New South Wales, Sydney, NSW, 2052, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Sydney, NSW, 2031, Australia.,University of New South Wales, Sydney, NSW, 2052, Australia
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19
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Abstract
Proprioception, which can be defined as the awareness of the mechanical and spatial state of the body and its musculoskeletal parts, is critical to motor actions and contributes to our sense of body ownership. To date, clinical proprioceptive tests have focused on a person's ability to detect, discriminate or match limb positions or movements, and reveal that the strength of the relationship between deficits in proprioception and physical function varies widely. Unfortunately, these tests fail to assess higher-level proprioceptive abilities. In this Perspective, we propose that to understand fully the link between proprioception and function, we need to look beyond traditional clinical tests of proprioception. Specifically, we present a novel framework for human proprioception assessment that is divided into two categories: low-level and high-level proprioceptive judgments. Low-level judgments are those made in a single frame of reference and are the types of judgments made in traditional proprioceptive tests (i.e. detect, discriminate or match). High-level proprioceptive abilities involve proprioceptive judgments made in a different frame of reference. For example, when a person indicates where their hand is located in space. This framework acknowledges that proprioception is complex and multifaceted, and that tests of proprioception should not be viewed as interchangeable, but rather as complimentary. Crucially, it provides structure to the way researchers and clinicians can approach proprioception and its assessment. We hope this Perspective serves as the catalyst for discussion and new lines of investigation.
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Affiliation(s)
- Martin E Heroux
- Neuroscience Research Australia, Sydney, NSW, Australia.,University of New South Wales, School of Medical Sciences, Kensington, NSW, Australia
| | - Annie A Butler
- Neuroscience Research Australia, Sydney, NSW, Australia.,University of New South Wales, School of Medical Sciences, Kensington, NSW, Australia
| | - Lucy S Robertson
- Neuroscience Research Australia, Sydney, NSW, Australia.,University of New South Wales, School of Medical Sciences, Kensington, NSW, Australia
| | | | - Simon C Gandevia
- Neuroscience Research Australia, Sydney, NSW, Australia.,University of New South Wales, Clinical School, NSW, Australia
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20
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Yeung J, Burke PGR, Knapman FL, Patti J, Brown EC, Gandevia SC, Eckert DJ, Butler JE, Bilston LE. Task-dependent neural control of regions within human genioglossus. J Appl Physiol (1985) 2022; 132:527-540. [PMID: 34989652 DOI: 10.1152/japplphysiol.00478.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Anatomical and imaging evidence suggests neural control of oblique and horizontal compartments of the genioglossus differs. However, neurophysiological evidence for differential control remains elusive. This study aimed to determine whether there are differences in neural drive to the oblique and horizontal regions of the genioglossus during swallowing and tongue protrusion. Adult participants (N=63; 48M) were recruited from a sleep clinic; 41 had Obstructive Sleep Apnoea (OSA: 34M, 8F). Electromyographic (EMG) was recorded at rest (awake, supine) using 4 intramuscular fine-wire electrodes inserted percutaneously into the anterior oblique, posterior oblique, anterior horizontal and posterior horizontal genioglossus. Epiglottic pressure and nasal airflow were also measured. During swallowing, two distinct EMG patterns were observed- a monophasic response (single EMG peak) and a biphasic response (two bursts of EMG). Peak EMG and timing of the peak relative to epiglottic pressure were significantly different between patterns (linear mixed models, p<0.001). Monophasic activation was more likely in the horizontal than oblique region during swallowing (OR=6.83, CI=3.46-13.53, p<0.001). In contrast, during tongue protrusion, activation patterns and EMG magnitude were not different between regions. There were no systematic differences in EMG patterns during swallowing or tongue protrusion between OSA and non-OSA groups. These findings provide evidence for functional differences in the motoneuronal output to the oblique and horizontal compartments, enabling differential task-specific drive. Given this, it is important to identify the compartment from which EMG is acquired. We propose that the EMG patterns during swallowing may be used to identify the compartment where a recording electrode is located.
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Affiliation(s)
- Jade Yeung
- grid.250407.4Neuroscience Research Australia, Sydney, New South Wales, Australia
| | | | - Fiona L Knapman
- grid.250407.4Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Jessica Patti
- grid.250407.4Neuroscience Research Australia, Randwick, Australia
| | - Elizabeth C Brown
- Neuroscience Research Australia, University of New South Wales, Randwick, NSW, Australia
| | - Simon C Gandevia
- grid.250407.4Neuroscience Research Australia, Randwick, Sydney, New South Wales, Australia
| | - Danny J Eckert
- Adelaide Institute for Sleep Health (AISH)/ Flinders Health and Medical Research Institute Sleep Health, grid.1014.4Flinders University, Bedford Park, SA, Australia
| | - Jane E Butler
- grid.250407.4Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Lynne E Bilston
- Neuroscience Research Australia, grid.1005.4Neuroscience Research Australia, Randwick, Australia
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21
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Ingram LA, Butler AA, Brodie MA, Hoang P, Gandevia SC, Lord SR. Original articleQuantifying upper-limb motor impairment in people with multiple sclerosis: a physiological profiling approach. Ann Phys Rehabil Med 2021; 65:101625. [PMID: 34958919 DOI: 10.1016/j.rehab.2021.101625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 11/17/2021] [Accepted: 11/21/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND . Upper-limb sensory and motor impairments are common in people with multiple sclerosis (MS), yet the current gold standard criteria for documenting functional impairment largely focuses on mobility, balance and postural stability. OBJECTIVE . We aimed to determine the validity of the upper-limb Physiological Profile Assessment (PPA) in people with MS by investigating whether the included domains of muscle strength, dexterity, arm stability, position sense, skin sensation and bimanual coordination 1) are sensitive in differentiating people with MS from healthy controls and 2) correlate with a validated measure of upper-limb function and a scale for quantifying disability in MS. METHODS . In a cross-sectional study, 40 participants with MS and 80 healthy controls completed all 13 of the upper-limb PPA tests within a single session. RESULTS . People with MS were impaired across all physiological domains tested. Performance in 4 of the 13 tests was correlated with a validated measure of self-reported upper-limb function (Pearson's r or Spearman's rho -0.333-0.441), whereas 3 tests were associated with the degree of MS-specific disability (Spearman's rho -0.318; 0.456). CONCLUSIONS . The upper-limb PPA offers a valid and clinically suitable assessment of upper-limb function in people with MS. Clinicians should prioritise assessments of motor speed, fine motor control and functional tasks in their assessment of upper-limb function in people with MS because these domains are the most commonly and significantly impaired.
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Affiliation(s)
- Lewis A Ingram
- Neuroscience Research Australia, Sydney, New South Wales, Australia; University of South Australia, Adelaide, South Australia, Australia.
| | - Annie A Butler
- Neuroscience Research Australia, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew A Brodie
- Neuroscience Research Australia, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia
| | - Phu Hoang
- Neuroscience Research Australia, Sydney, New South Wales, Australia; Multiple Sclerosis Limited, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia
| | - Stephen R Lord
- Neuroscience Research Australia, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia
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22
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Butler AA, Robertson LS, Wang AP, Gandevia SC, Héroux ME. Do interoception and attending to the upper limbs affect body ownership and body representation in the grasp illusion? PLoS One 2021; 16:e0259988. [PMID: 34788333 PMCID: PMC8598028 DOI: 10.1371/journal.pone.0259988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 10/29/2021] [Indexed: 11/18/2022] Open
Abstract
Passively grasping an unseen artificial finger induces ownership over this finger and an illusory coming together of one's index fingers: a grasp illusion. Here we determine how interoceptive ability and attending to the upper limbs influence this illusion. Participants passively grasped an unseen artificial finger with their left index finger and thumb for 3 min while their right index finger, located 12 cm below, was lightly clamped. Experiment 1 (n = 30) investigated whether the strength of the grasp illusion (perceived index finger spacing and perceived ownership) is related to a person's level of interoceptive accuracy (modified heartbeat counting task) and sensibility (Noticing subscale of the Multidimensional Assessment of Interoceptive Awareness). Experiment 2 (n = 30) investigated the effect of providing verbal or tactile cues to guide participants' attention to their upper limbs. On their own, neither interoceptive accuracy and sensibility or verbal and tactile cueing had an effect on the grasp illusion. However, verbal cueing increased the strength of the grasp illusion in individuals with lower interoceptive ability. Across the observed range of interoceptive accuracy and sensibility, verbal cueing decreased perceived index spacing by 5.6 cm [1.91 to 9.38] (mean [95%CI]), and perceived ownership by ∼3 points on a 7-point Likert scale (slope -0.93 [-1.72 to -0.15]). Thus, attending to the upper limbs via verbal cues increases the strength of the grasp illusion in a way that is inversely proportional to a person's level of interoceptive accuracy and sensibility.
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Affiliation(s)
- Annie A. Butler
- Neuroscience Research Australia, Randwick, NSW, Australia
- University of New South Wales, Randwick, NSW, Australia
| | - Lucy S. Robertson
- Neuroscience Research Australia, Randwick, NSW, Australia
- University of New South Wales, Randwick, NSW, Australia
| | | | - Simon C. Gandevia
- Neuroscience Research Australia, Randwick, NSW, Australia
- University of New South Wales, Randwick, NSW, Australia
- * E-mail:
| | - Martin E. Héroux
- Neuroscience Research Australia, Randwick, NSW, Australia
- University of New South Wales, Randwick, NSW, Australia
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23
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Narang I, Carberry JC, Butler JE, Gandevia SC, Chiang AKI, Eckert DJ. Physiological Responses and Perceived Comfort to High Flow Nasal Cannula Therapy in Awake Adults: Effects of Flow Magnitude and Temperature. J Appl Physiol (1985) 2021; 131:1772-1782. [PMID: 34709070 DOI: 10.1152/japplphysiol.00085.2021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Clinical use of heated, high flow nasal cannula (HFNC) for non-invasive respiratory support is increasing and may have a therapeutic role in stabilizing the upper airway in obstructive sleep apnea (OSA). However, physiological mechanisms by which HFNC therapy may improve upper-airway function and effects of different temperature modes are unclear. Accordingly, this study aimed to determine effects of incremental flows and temperature modes (heated and non-heated) of HFNC on upper airway muscle activity (genioglossus), pharyngeal airway pressure, breathing parameters and perceived comfort. Six participants (2 females, aged 35±14 years) were studied during wakefulness in supine position and received HFNC at variable flows (0-60 L/min) during heated (37ºC) and non-heated (21ºC) modes. Breathing parameters via calibrated Respitrace inductance bands (chest and abdomen), upper-airway pressures via airway transducers, and genioglossus muscle activity via intra-muscular bipolar fine wire electrodes were measured. Comfort levels during HFNC were quantified using a visual analogue scale. Increasing HFNC flows did not increase genioglossus muscle activation despite increased negative epiglottic pressure swings (p=0.009). HFNC provided ~7cmH2O positive airway pressure at 60 L/min in non-heated and heated modes. In addition, increasing the magnitude of HFNC flow reduced breathing frequency (p=0.045), increased expiratory time (p=0.040), increased peak inspiratory flow (p=0.002), and increased discomfort (p=0.004). Greater discomfort occurred at higher flows in non-heated versus heated mode (p=0.034). These findings provide novel insight into key physiological changes that occur with HFNC for respiratory support and indicate the primary mechanism for improved upper-airway stability is positive airway pressure, not increased pharyngeal muscle activity.
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Affiliation(s)
- Indra Narang
- Translational Medicine, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,Neuroscience Research Australia (NeuRA), Randwick, Sydney, NSW, Australia
| | - Jayne C Carberry
- Neuroscience Research Australia (NeuRA), Randwick, Sydney, NSW, Australia.,School Of Medicine, University College Dublin, Dublin, Ireland
| | - Jane E Butler
- Neuroscience Research Australia (NeuRA), Randwick, Sydney, NSW, Australia.,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia (NeuRA), Randwick, Sydney, NSW, Australia.,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Alan K I Chiang
- Neuroscience Research Australia (NeuRA), Randwick, Sydney, NSW, Australia
| | - Danny J Eckert
- Neuroscience Research Australia (NeuRA), Randwick, Sydney, NSW, Australia.,Flinders Health and Medical Research Institute Sleep Health/Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia.,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
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24
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Luu BL, Walsh LD, Hübner PP, Eckert DJ, Bilston LE, Gandevia SC, Butler JE. Tongue acceleration in humans evoked with intramuscular electrical stimulation of genioglossus. Respir Physiol Neurobiol 2021; 295:103786. [PMID: 34508867 DOI: 10.1016/j.resp.2021.103786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/23/2021] [Accepted: 09/03/2021] [Indexed: 02/06/2023]
Abstract
Genioglossus was stimulated intramuscularly to determine the effect of regional activation of the muscle on tongue movement in eight healthy adults. Stimulation at motor threshold was delivered with a needle electrode inserted to different depths in the anterior and posterior regions of genioglossus. The current amplitude that induced muscle contraction was ∼80% higher for anterior than posterior sites. Evoked tongue movements were determined from stimulus-triggered averages (150 pulses) of the outputs from an accelerometer fixed to the posterosuperior surface of the tongue. The median amplitude [95% confidence intervals] for the resultant acceleration was 0.0 m/s2 [0.0, 0.2] for anterior and 0.6 m/s2 [0.1, 2.8] for posterior sites. There was a positive relationship between acceleration amplitude and stimulation depth in the posterior of genioglossus (p < 0.001), but acceleration amplitude did not vary with stimulation depth in the anterior region (p = 0.83). This heterogeneity in acceleration responses between muscle regions may contribute to differences in collapsibility of the upper airway.
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Affiliation(s)
- Billy L Luu
- Neuroscience Research Australia, Randwick, NSW, Australia
| | - Lee D Walsh
- Neuroscience Research Australia, Randwick, NSW, Australia; University of New South Wales, Sydney, NSW, Australia; Platypus Technical Consultants Pty Ltd, Canberra, Australia
| | - Patrick P Hübner
- Neuroscience Research Australia, Randwick, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Danny J Eckert
- Neuroscience Research Australia, Randwick, NSW, Australia; University of New South Wales, Sydney, NSW, Australia; Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia
| | - Lynne E Bilston
- Neuroscience Research Australia, Randwick, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Randwick, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Jane E Butler
- Neuroscience Research Australia, Randwick, NSW, Australia; University of New South Wales, Sydney, NSW, Australia.
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25
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Jugé L, Olsza I, Knapman FL, Burke PGR, Brown EC, Stumbles E, Bosquillon de Frescheville AF, Gandevia SC, Eckert DJ, Butler JE, Bilston LE. Effect of upper airway fat on tongue dilation during inspiration in awake people with obstructive sleep apnea. Sleep 2021; 44:6330603. [PMID: 34323992 DOI: 10.1093/sleep/zsab192] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 07/19/2021] [Indexed: 01/20/2023] Open
Abstract
STUDY OBJECTIVES To investigate the effect of upper airway fat composition on tongue inspiratory movement and obstructive sleep apnea (OSA). METHODS Participants without or with untreated OSA underwent a 3T magnetic resonance imaging (MRI) scan. Anatomical measurements were obtained from T2-weighted images. Mid-sagittal inspiratory tongue movements were imaged using tagged MRI during wakefulness. Tissue volumes and percentages of fat were quantified using an mDIXON scan. RESULTS 40 predominantly overweight participants with OSA were compared to 10 predominantly normal weight controls. After adjusting for age, BMI and gender, the percentage of fat in the tongue was not different between groups (ANCOVA, P=0.45), but apnoeic patients had a greater tongue volume (ANCOVA, P=0.025). After adjusting for age, BMI and gender, higher OSA severity was associated with larger whole tongue volume (r=0.51, P<0.001), and greater dilatory motion of the anterior horizontal tongue compartment (r=-0.33, P=0.023), but not with upper airway fat percentage. Higher tongue fat percentage was associated with higher BMI and older age (Spearman r=0.43, P=0.002, and r=0.44, P=0.001, respectively), but not with inspiratory tongue movements. Greater inspiratory tongue movement was associated with larger tongue volume (e.g. horizontal posterior compartment, r=-0.44, P=0.002) and smaller nasopharyngeal airway (e.g. oblique compartment, r=0.29, P=0.040). CONCLUSIONS Larger tongue volume and a smaller nasopharynx are associated with increased inspiratory tongue dilation during wakefulness in people with and without OSA. This compensatory response was not influenced by higher tongue fat content. Whether this is also true in more obese patient populations requires further investigation.
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Affiliation(s)
- Lauriane Jugé
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Ida Olsza
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Fiona L Knapman
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Peter G R Burke
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia.,Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Elizabeth C Brown
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Emma Stumbles
- Prince of Wales Hospital, Sydney, New South Wales, Australia
| | | | - Simon C Gandevia
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Danny J Eckert
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia.,Flinders Health and Medical Research Institute (FHMRI) and FHMRI Sleep Health/Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
| | - Jane E Butler
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Lynne E Bilston
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
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26
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Ingram LA, Butler AA, Brodie MA, Lord SR, Gandevia SC. Quantifying upper limb motor impairment in chronic stroke: a physiological profiling approach. J Appl Physiol (1985) 2021; 131:949-965. [PMID: 34264125 DOI: 10.1152/japplphysiol.00078.2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Upper limb motor impairments, such as muscle weakness, loss of dexterous movement, and reduced sensation, are common after a stroke. The extent and severity of these impairments differ among individuals, depending on the anatomical location and size of lesions. Identifying impairments specific to the individual is critical to optimize their functional recovery. The upper limb Physiological Profile Assessment (PPA) provides quantitative measures of key physiological domains required for adequate function in the upper limbs. The present study investigates the use of the upper limb PPA in a chronic stroke population. Fifty participants with chronic stroke completed all tests of the upper limb PPA with both their affected and less affected upper limbs. Performance in each test was compared to that of 50 age- and sex-matched control subjects with no history of a stroke. Correlations between test performance and validated measures of stroke, sensorimotor function, and disability were examined. Compared with control subjects, people with stroke demonstrated substantially impaired upper limb PPA performance for both their affected and less affected limbs. Performance in the upper limb PPA was associated with validated measures of sensorimotor function specific to the stroke population (Fugl-Meyer Assessment) and stroke-related disability (Stroke Impact Scale). The upper limb PPA shows good concurrent validity as a means to quantify upper limb function in a chronic stroke population. These tests identify domain-specific deficits and could be further tailored to an individual patient by the clinician to inform rehabilitation and track recovery.NEW & NOTEWORTHY Upper limb motor impairment is a common manifestation after stroke, compromising independence in fundamental daily activities involving the ability to reach, grasp, and manipulate objects. The upper limb Physiological Profile Assessment (PPA) offers a means of quantifying performance of the individual sensorimotor domains that are essential for upper limb function. Establishing individual performance profiles based on age- and sex-based normative scores may facilitate individualized treatment decisions by identifying the stroke patient's specific strengths and limitations.
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Affiliation(s)
- Lewis A Ingram
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Annie A Butler
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew A Brodie
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Stephen R Lord
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
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27
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Epiu I, Gandevia SC, Boswell-Ruys CL, Wallace E, Butler JE, Hudson AL. Tongue strength and swallowing dynamics in chronic obstructive pulmonary disease. ERJ Open Res 2021; 7:00192-2021. [PMID: 34262969 PMCID: PMC8273391 DOI: 10.1183/23120541.00192-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/27/2021] [Indexed: 01/25/2023] Open
Abstract
Background Swallowing disorders occur in COPD, but little is known about tongue strength and mastication. This is the first assessment in COPD of tongue strength and a test of mastication and swallowing solids (TOMASS). Methods Anterior tongue strength measures were obtained in 18 people with COPD, aged 73±11 years (mean±sd), and 19 healthy age-matched controls, aged 72±6 years. Swallowing dynamics were assessed using an eating assessment tool (EAT-10), timed water swallow test (TWST), and TOMASS. Swallowing measures were compared to an inhibitory reflex (IR) in the inspiratory muscles to airway occlusion (recorded previously in the same participants). Results Tongue strength was similar between COPD and controls (p=0.715). Self-assessed scores of dysphagia EAT-10 were higher (p=0.024) and swallowing times were prolonged for liquids (p=0.022) and solids (p=0.003) in the COPD group. During TWST, ∼30% of COPD group showed clinical signs of airway invasion (cough and wet voice), but none in the control group. For solids, the COPD group had ∼40% greater number of chews (p=0.004), and twofold-higher number of swallows (p=0.0496). Respiratory rate was 50% higher in COPD group than controls (p <0.001). The presence of an IR was not related to better swallowing outcomes, but signs of airway invasion were associated with a delayed IR. Conclusion Dysphagia in stable COPD is not due to impaired anterior tongue strength, but rather swallowing–breathing discoordination. To address dysphagia, aspiration and acute exacerbations in COPD, therapeutic targets to improve swallowing dynamics could be investigated further. In this novel study of swallowing in COPD, there was no difference in tongue strength when compared to healthy controls, and in COPD participants with airway invasion, the inhibitory reflex to airway occlusion in inspiratory muscles was delayedhttps://bit.ly/3h4EeKw
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Affiliation(s)
- Isabella Epiu
- Neuroscience Research Australia, Sydney, NSW, Australia.,University of New South Wales Sydney, NSW, Australia.,Prince of Wales Hospital, Sydney, NSW, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Sydney, NSW, Australia.,University of New South Wales Sydney, NSW, Australia.,Prince of Wales Hospital, Sydney, NSW, Australia
| | - Claire L Boswell-Ruys
- Neuroscience Research Australia, Sydney, NSW, Australia.,University of New South Wales Sydney, NSW, Australia.,Prince of Wales Hospital, Sydney, NSW, Australia
| | - Emma Wallace
- Neuroscience Research Australia, Sydney, NSW, Australia.,Flinders University, Adelaide, SA, Australia
| | - Jane E Butler
- Neuroscience Research Australia, Sydney, NSW, Australia.,University of New South Wales Sydney, NSW, Australia
| | - Anna L Hudson
- Neuroscience Research Australia, Sydney, NSW, Australia.,University of New South Wales Sydney, NSW, Australia
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28
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Manca A, Hortobágyi T, Carroll TJ, Enoka RM, Farthing JP, Gandevia SC, Kidgell DJ, Taylor JL, Deriu F. Contralateral Effects of Unilateral Strength and Skill Training: Modified Delphi Consensus to Establish Key Aspects of Cross-Education. Sports Med 2021; 51:11-20. [PMID: 33175329 PMCID: PMC7806569 DOI: 10.1007/s40279-020-01377-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Background Cross-education refers to increased motor output (i.e., force generation, skill) of the opposite, untrained limb following a period of unilateral exercise training. Despite extensive research, several aspects of the transfer phenomenon remain controversial. Methods A modified two-round Delphi online survey was conducted among international experts to reach consensus on terminology, methodology, mechanisms of action, and translational potential of cross-education, and to provide a framework for future research. Results Through purposive sampling of the literature, we identified 56 noted experts in the field, of whom 32 completed the survey, and reached consensus (75% threshold) on 17 out of 27 items. Conclusion Our consensus-based recommendations for future studies are that (1) the term ‘cross-education’ should be adopted to refer to the transfer phenomenon, also specifying if transfer of strength or skill is meant; (2) functional magnetic resonance imaging, short-interval intracortical inhibition and interhemispheric inhibition appear to be promising tools to study the mechanisms of transfer; (3) strategies which maximize cross-education, such as high-intensity training, eccentric contractions, and mirror illusion, seem worth being included in the intervention plan; (4) study protocols should be designed to include at least 13–18 sessions or 4–6 weeks to produce functionally meaningful transfer of strength, and (5) cross-education could be considered as an adjuvant treatment particularly for unilateral orthopedic conditions and sports injuries. Additionally, a clear gap in views emerged between the research field and the purely clinical field. The present consensus statement clarifies relevant aspects of cross-education including neurophysiological, neuroanatomical, and methodological characteristics of the transfer phenomenon, and provides guidance on how to improve the quality and usability of future cross-education studies. Electronic supplementary material The online version of this article (10.1007/s40279-020-01377-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A Manca
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/b, 07100, Sassari, Italy
| | - T Hortobágyi
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - T J Carroll
- Centre for Sensorimotor Performance, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - R M Enoka
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, USA
| | - J P Farthing
- University of Saskatchewan College of Kinesiology, Saskatoon, SK, Canada
| | - S C Gandevia
- Neuroscience Research Australia (NeuRA), The University of New South Wales, Sydney, Australia
| | - D J Kidgell
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Australia
| | - J L Taylor
- School of Medical and Health Sciences, Edit Cowan University, Joondalup, Australia
| | - F Deriu
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/b, 07100, Sassari, Italy.
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29
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Epiu I, Gandevia SC, Boswell-Ruys CL, Basha C, Archer SNJ, Butler JE, Hudson AL. Inspiratory muscle responses to sudden airway occlusion in chronic obstructive pulmonary disease. J Appl Physiol (1985) 2021; 131:36-44. [PMID: 33955264 DOI: 10.1152/japplphysiol.00017.2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Brief airway occlusion produces a potent reflex inhibition of inspiratory muscles that is thought to protect against aspiration. Its duration is prolonged in asthma and obstructive sleep apnea. We assessed this inhibitory reflex (IR) in chronic obstructive pulmonary disease (COPD). Reflex responses to brief (250 ms) inspiratory occlusions were measured in 18 participants with moderate to severe COPD (age 73 ± 11 yr) and 17 healthy age-matched controls (age 72 ± 6 yr). We compared the incidence and properties of the IR between groups. Median eupneic preocclusion electromyographic activity was higher in the COPD group than controls (9.4 μV vs. 5.2 μV, P = 0.001). Incidence of the short-latency IR was higher in the COPD group compared with controls (15 participants vs. 7 participants, P = 0.010). IR duration for scalenes was similar for the COPD and control groups [73 ± 37 ms (means ± SD) and 90 ± 50 ms, respectively] as was the magnitude of inhibition. IRs in the diaphragm were not detected in the controls but were present in 9 participants of the COPD group (P = 0.001). The higher incidence of the IR in the COPD group than in the age-matched controls may reflect the increased inspiratory neural drive in the COPD group. This higher drive counteracts changes in chest wall and lung mechanics. However, when present, the reflex was similar in size and duration in the two groups. The relation between the IR in COPD and swallowing function could be assessed.NEW & NOTEWORTHY A potent short-latency reflex inhibition of inspiratory muscles produced by airway occlusion was tested in people with COPD and age-matched controls. The reflex was more prevalent in COPD, presumably due to an increased neural drive to breathe. When present, the reflex was similar in duration in the two groups, longer than historical data for younger control groups. The work reveals novel differences in reflex control of inspiratory muscles due to aging as well as COPD.
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Affiliation(s)
- Isabella Epiu
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Claire L Boswell-Ruys
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Chanelle Basha
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,Department of Physiotherapy, Macquarie University, Sydney, New South Wales, Australia
| | - Sean N J Archer
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,Department of Physiotherapy, Macquarie University, Sydney, New South Wales, Australia
| | - Jane E Butler
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Anna L Hudson
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Kishimoto KC, Héroux ME, Gandevia SC, Butler JE, Diong J. Estimation of maximal muscle electromyographic activity from the relationship between muscle activity and voluntary activation. J Appl Physiol (1985) 2021; 130:1352-1361. [PMID: 33600280 DOI: 10.1152/japplphysiol.00557.2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Maximal muscle activity recorded with surface electromyography (EMG) is an important neurophysiological measure. It is frequently used to normalize EMG activity recorded during passive or active movement. However, the true maximal muscle activity cannot be determined in people with impaired capacity to voluntarily activate their muscles. Here, we determined whether maximal muscle activity can be estimated from muscle activity produced during submaximal voluntary activation. Twenty-five able-bodied adults (18 males, mean age 29 yr, range 19-64 yr) participated in the study. Participants were seated with the knee flexed 90° and the ankle in 5° of dorsiflexion from neutral. Participants performed isometric voluntary ankle plantarflexion contractions at target torques, in random order: 1, 5, 10, 15, 25, 50, 75, 90, 95, and 100% of maximal voluntary torque. Ankle torque, muscle activity in soleus, medial and lateral gastrocnemius muscles, and voluntary muscle activation determined using twitch interpolation were recorded. There was a strong loge-linear relationship between measures of muscle activation and muscle activity in all three muscles tested. Linear mixed models were fitted to muscle activation and loge-transformed EMG data. Each 1% increase in muscle activation increased muscle activity by a mean of 0.027 ln(mV) [95% confidence interval (CI) 0.025 to 0.029 ln(mV)] in soleus, 0.025 ln(mV) [0.022 to 0.028 ln(mV)] in medial gastrocnemius, and 0.028 ln(mV) [0.026 to 0.030 ln(mV)] in lateral gastrocnemius. The relationship between voluntary muscle activation and muscle activity can be described with simple mathematical functions. In future, it should be possible to normalize recorded muscle activity using these types of functions.NEW & NOTEWORTHY Muscle activity is often normalized to maximal muscle activity; however, it is difficult to obtain accurate measures of maximal muscle activity in people with impaired voluntary neural drive. We determined the relationship between voluntary muscle activation and plantarflexor muscle activity across a broad range of muscle activation values in able-bodied people. The relationship between voluntary muscle activation and muscle activity can be described with simple mathematical functions capable of estimating maximal muscle activity.
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Affiliation(s)
- Kenzo C Kishimoto
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Martin E Héroux
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Jane E Butler
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Joanna Diong
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,Discipline of Anatomy and Histology, Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, New South Wales, Australia
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31
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Hoang PD, Psarakis M, Kwah LK, Clarke JL, Gandevia SC, Diong J. Brief report: Passive mechanical properties of gastrocnemius in multiple sclerosis and ankle contracture. Clin Biomech (Bristol, Avon) 2021; 84:105338. [PMID: 33812198 DOI: 10.1016/j.clinbiomech.2021.105338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 01/21/2021] [Accepted: 03/19/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ankle contracture is common in people with multiple sclerosis (MS) but the mechanisms of contracture are not clear. This study aimed to identify the mechanisms of contracture in MS by comparing passive muscle length and stiffness at known tension, separated into contributions by muscle fascicles and tendons, between people with MS who had contracture and healthy people. METHODS Passive length-tension curves of the gastrocnemius muscle-tendon unit were derived from passive ankle torque and angle using a published biomechanical method. Ultrasound images of medial gastrocnemius muscle fascicles were used to partition length-tension curves into fascicle and tendon components. Lengths and stiffness of the muscle-tendon unit, muscle fascicles and tendons were compared between groups with linear regression. FINDINGS Data were obtained from 15 participants with MS who had contracture [age 53 (12) years, mean (SD)] and 25 healthy participants [48 (20) years]. Participants with MS had clinically significant ankle contracture, and had shorter fascicles at slack length (between-groups mean difference -0.8 cm, 95% CI -1.2 to -0.4 cm, p < 0.001) and at 100 N (-0.7 cm, 95% CI -1.3 to -0.1 cm, p = 0.02) compared to healthy participants. There were no differences between groups in all other outcomes. INTERPRETATION Tension-referenced comparisons of passive muscle length and stiffness show that people with MS who had contracture had shorter fascicles at low and high tension compared to healthy people, but there were no changes to the muscle-tendon unit or tendon. Further studies are needed to identify the causes and mechanisms of contracture in neurological conditions.
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Affiliation(s)
- Phu D Hoang
- Neuroscience Research Australia (NeuRA) and University of New South Wales, NSW, Australia.
| | - Michael Psarakis
- School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, NSW, Australia
| | - Li Khim Kwah
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore
| | - Jillian L Clarke
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia (NeuRA) and University of New South Wales, NSW, Australia
| | - Joanna Diong
- Neuroscience Research Australia (NeuRA) and University of New South Wales, NSW, Australia; School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Australia
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Ingram LA, Carroll VK, Butler AA, Brodie MA, Gandevia SC, Lord SR. Quantifying upper limb motor impairment in people with Parkinson's disease: a physiological profiling approach. PeerJ 2021; 9:e10735. [PMID: 33604177 PMCID: PMC7869669 DOI: 10.7717/peerj.10735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 12/17/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Upper limb motor impairments, such as slowness of movement and difficulties executing sequential tasks, are common in people with Parkinson's disease (PD). OBJECTIVE To evaluate the validity of the upper limb Physiological Profile Assessment (PPA) as a standard clinical assessment battery in people with PD, by determining whether the tests, which encompass muscle strength, dexterity, arm stability, position sense, skin sensation and bimanual coordination can (a) distinguish people with PD from healthy controls, (b) detect differences in upper limb test domains between "off" and "on" anti-Parkinson medication states and (c) correlate with a validated measure of upper limb function. METHODS Thirty-four participants with PD and 68 healthy controls completed the upper limb PPA tests within a single session. RESULTS People with PD exhibited impaired performance across most test domains. Based on validity, reliability and feasibility, six tests (handgrip strength, finger-press reaction time, 9-hole peg test, bimanual pole test, arm stability, and shirt buttoning) were identified as key tests for the assessment of upper limb function in people with PD. CONCLUSIONS The upper limb PPA provides a valid, quick and simple means of quantifying specific upper limb impairments in people with PD. These findings indicate clinical assessments should prioritise tests of muscle strength, unilateral movement and dexterity, bimanual coordination, arm stability and functional tasks in people with PD as these domains are the most commonly and significantly impaired.
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Affiliation(s)
- Lewis A. Ingram
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Vincent K. Carroll
- NSW Health, Mid North Coast Local Health District, Coffs Harbour, New South Wales, Australia
- Parkinson’s NSW, Sydney, New South Wales, Australia
| | - Annie A. Butler
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew A. Brodie
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Simon C. Gandevia
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Stephen R. Lord
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
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33
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Djajadikarta ZJ, Dongés SC, Brooks J, Kennedy DS, Gandevia SC, Taylor JL. Impaired central drive to plantarflexors and minimal ankle proprioceptive deficit in people with multiple sclerosis. Mult Scler Relat Disord 2020; 46:102584. [PMID: 33296980 DOI: 10.1016/j.msard.2020.102584] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/16/2020] [Accepted: 10/13/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND A common and disruptive symptom of multiple sclerosis is difficulty in walking. Deficits in ankle proprioception and in plantarflexor muscle function may contribute to these mobility issues. In this study, ankle proprioceptive ability and plantarflexor performance of people with multiple sclerosis (PwMS) were compared to healthy controls to determine whether multiple sclerosis causes impairments in these systems. METHODS PwMS (n = 30, median EDSS 4.0, IQR 2) were compared to age- and sex-matched healthy controls (n = 30) across tests of ankle proprioception and plantarflexor muscle performance. Proprioceptive tests: detection of passive movement, reaction time and ankle joint position sense. Plantarflexor performance: strength, fatigue, recovery and voluntary activation (level of neural drive) of the plantarflexor muscles, assessed through brief and sustained fatiguing (2 min) isometric maximal voluntary contractions with nerve stimulation to evoke superimposed and resting muscle twitches. RESULTS PwMS had unimpaired movement detection and joint position sense but had a slower reaction time to respond with plantarflexion to an imposed ankle movement (between group difference = 0.11 [95% CI; 0.05 to 0.17] s). During brief, maximal contractions PwMS produced lower torque (difference = -25.1 [-42.0 to -8.2] Nm) with reduced voluntary activation (difference = -14.6 [-25.1 to -4.1]%) but no impairment of the muscle itself (resting twitch torque difference = 0.3 [-2.8 to 2.2] Nm). At the end of the fatiguing contraction, neural drive decreased for PwMS (-19.5 [-27.1 to -11.9]%, p <0.0001) but not for controls (-2.5 [-6.9 to 1.8]%, p = 0.242). Fatigue did not affect the resting twitch size for controls (-1.3 [-2.7 to -0.03] Nm, p = 0.134) or PwMS (-0.1 [-1.1 to 1.0] Nm, p = 0.90). CONCLUSIONS PwMS showed no deficit in their ability to sense ankle position or imposed movements but were slow when a motor response was required. Their plantarflexor muscles produced similar torque with electrical stimulation but voluntary strength was impaired. Both groups experienced overall fatigue following the 2-minute maximal voluntary contraction but PwMS also had significantly reduced neural drive indicating central fatigue. PwMS showed mainly central deficits in motor output at the ankle with little impairment of proprioceptive acuity.
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Affiliation(s)
| | | | - Jack Brooks
- Neuroscience Research Australia, Sydney, NSW, Australia
| | - David S Kennedy
- Neuroscience Research Australia, Sydney, NSW, Australia; Graduate School of Health, Physiotherapy, University of Technology Sydney, Australia.
| | - Simon C Gandevia
- Neuroscience Research Australia, Sydney, NSW, Australia; University of New South Wales, Sydney, Australia.
| | - Janet L Taylor
- Neuroscience Research Australia, Sydney, NSW, Australia; Edith Cowan University, Joondalup, Perth, WA, Australia.
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Luu BL, Saboisky JP, Taylor JL, Gorman RB, Gandevia SC, Butler JE. Supraspinal fatigue in human inspiratory muscles with repeated sustained maximal efforts. J Appl Physiol (1985) 2020; 129:1365-1372. [PMID: 33002378 DOI: 10.1152/japplphysiol.00610.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
To investigate the involvement of supraspinal fatigue in the loss of maximal inspiratory pressure (Pimax), we fatigued the inspiratory muscles. Six participants performed 5 sustained maximal isometric inspiratory efforts (15-s contractions, duty cycle ∼75%) which reduced Pimax, as measured from esophageal and mouth pressure, to around half of their initial maximums. Transcranial magnetic stimulation (TMS) delivered over the motor cortex near the beginning and end of each maximal effort evoked superimposed twitch-like increments in the ongoing Pimax, increasing from ∼1.0% of Pimax in the unfatigued contractions to ≥40% of ongoing Pimax for esophageal and mouth pressures. The rate of increase in the superimposed twitch as Pimax decreased with fatigue was not significantly different between the esophageal and mouth pressure measures. The inverse relationship between superimposed twitch pressure and Pimax indicates a progressive decline in the ability of motor cortical output to drive the inspiratory muscles maximally, leading to the development of supraspinal fatigue. TMS also evoked silent periods in the electromyographic recordings of diaphragm, scalenes, and parasternal intercostal. The duration of the silent period increased with fatigue in all three muscles, which suggests greater intracortical inhibition, with the largest change observed in the diaphragm. The peak rate of relaxation in pressure during the silent period slowed as fatigue developed, indicating peripheral contractile changes in the active inspiratory muscles. These changes in the markers of fatigue show that both central and peripheral fatigue contribute to the loss in Pimax when inspiratory muscles are fatigued with repeated sustained maximal efforts.NEW & NOTEWORTHY When the inspiratory muscles are fatigued with repeated sustained maximal efforts, supraspinal fatigue, a component of central fatigue, contributes to the loss in maximal inspiratory pressure. The presence of supraspinal fatigue was confirmed by the increase in amplitude of twitch-like increments in pressure evoked by motor cortical stimulation during maximal efforts, indicating that motor cortical output was not maximal as extra muscle force could be generated to increase inspiratory pressure.
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Affiliation(s)
- Billy L Luu
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Julian P Saboisky
- Neuroscience Research Australia, Randwick, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Janet L Taylor
- Neuroscience Research Australia, Randwick, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia.,Edith Cowan University, Joondalup, Western Australia, Australia
| | - Robert B Gorman
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Randwick, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Jane E Butler
- Neuroscience Research Australia, Randwick, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
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Jonkman AH, Frenzel T, McCaughey EJ, McLachlan AJ, Boswell-Ruys CL, Collins DW, Gandevia SC, Girbes ARJ, Hoiting O, Kox M, Oppersma E, Peters M, Pickkers P, Roesthuis LH, Schouten J, Shi ZH, Veltink PH, de Vries HJ, Shannon Weickert C, Wiedenbach C, Zhang Y, Tuinman PR, de Man AME, Butler JE, Heunks LMA. Breath-synchronized electrical stimulation of the expiratory muscles in mechanically ventilated patients: a randomized controlled feasibility study and pooled analysis. Crit Care 2020; 24:628. [PMID: 33126902 PMCID: PMC7596623 DOI: 10.1186/s13054-020-03352-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/16/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Expiratory muscle weakness leads to difficult ventilator weaning. Maintaining their activity with functional electrical stimulation (FES) may improve outcome. We studied feasibility of breath-synchronized expiratory population muscle FES in a mixed ICU population ("Holland study") and pooled data with our previous work ("Australian study") to estimate potential clinical effects in a larger group. METHODS Holland: Patients with a contractile response to FES received active or sham expiratory muscle FES (30 min, twice daily, 5 days/week until weaned). Main endpoints were feasibility (e.g., patient recruitment, treatment compliance, stimulation intensity) and safety. Pooled: Data on respiratory muscle thickness and ventilation duration from the Holland and Australian studies were combined (N = 40) in order to estimate potential effect size. Plasma cytokines (day 0, 3) were analyzed to study the effects of FES on systemic inflammation. RESULTS Holland: A total of 272 sessions were performed (active/sham: 169/103) in 20 patients (N = active/sham: 10/10) with a total treatment compliance rate of 91.1%. No FES-related serious adverse events were reported. Pooled: On day 3, there was a between-group difference (N = active/sham: 7/12) in total abdominal expiratory muscle thickness favoring the active group [treatment difference (95% confidence interval); 2.25 (0.34, 4.16) mm, P = 0.02] but not on day 5. Plasma cytokine levels indicated that early FES did not induce systemic inflammation. Using a survival analysis approach for the total study population, median ventilation duration and ICU length of stay were 10 versus 52 (P = 0.07), and 12 versus 54 (P = 0.03) days for the active versus sham group. Median ventilation duration of patients that were successfully extubated was 8.5 [5.6-12.2] versus 10.5 [5.3-25.6] days (P = 0.60) for the active (N = 16) versus sham (N = 10) group, and median ICU length of stay was 10.5 [8.0-14.5] versus 14.0 [9.0-19.5] days (P = 0.36) for those active (N = 16) versus sham (N = 8) patients that were extubated and discharged alive from the ICU. During ICU stay, 3/20 patients died in the active group versus 8/20 in the sham group (P = 0.16). CONCLUSION Expiratory muscle FES is feasible in selected ICU patients and might be a promising technique within a respiratory muscle-protective ventilation strategy. The next step is to study the effects on weaning and ventilator liberation outcome. TRIAL REGISTRATION ClinicalTrials.gov, ID NCT03453944. Registered 05 March 2018-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03453944 .
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Affiliation(s)
- Annemijn H Jonkman
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Postbox 7505, 1007 MB, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Tim Frenzel
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Euan J McCaughey
- Neuroscience Research Australia, 139 Barker Street, Randwick, NSW, 2031, Australia.,School of Medical Sciences, University of New South Wales, Kensington, NSW, 2052, Australia
| | | | - Claire L Boswell-Ruys
- Neuroscience Research Australia, 139 Barker Street, Randwick, NSW, 2031, Australia.,School of Medical Sciences, University of New South Wales, Kensington, NSW, 2052, Australia
| | | | - Simon C Gandevia
- Neuroscience Research Australia, 139 Barker Street, Randwick, NSW, 2031, Australia.,School of Medical Sciences, University of New South Wales, Kensington, NSW, 2052, Australia
| | - Armand R J Girbes
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Postbox 7505, 1007 MB, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Oscar Hoiting
- Department of Intensive Care Medicine, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Matthijs Kox
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eline Oppersma
- Cardiovascular and Respiratory Physiology Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Marco Peters
- Department of Intensive Care Medicine, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Peter Pickkers
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lisanne H Roesthuis
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jeroen Schouten
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Zhong-Hua Shi
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Postbox 7505, 1007 MB, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Peter H Veltink
- Department of Biomedical Signals and Systems, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Heder J de Vries
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Postbox 7505, 1007 MB, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Cyndi Shannon Weickert
- Neuroscience Research Australia, 139 Barker Street, Randwick, NSW, 2031, Australia.,School of Psychiatry, University of New South Wales, Kensington, NSW, 2052, Australia.,Department of Neuroscience and Physiology, Upstate Medical University, New York, 13210, USA
| | - Carsten Wiedenbach
- Department of Intensive Care Medicine, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Yingrui Zhang
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Postbox 7505, 1007 MB, Amsterdam, The Netherlands
| | - Pieter R Tuinman
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Postbox 7505, 1007 MB, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Angélique M E de Man
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Postbox 7505, 1007 MB, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jane E Butler
- Neuroscience Research Australia, 139 Barker Street, Randwick, NSW, 2031, Australia.,School of Medical Sciences, University of New South Wales, Kensington, NSW, 2052, Australia
| | - Leo M A Heunks
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Postbox 7505, 1007 MB, Amsterdam, The Netherlands. .,Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands.
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Lloyd RA, Butler JE, Gandevia SC, Ball IK, Toson B, Stoodley MA, Bilston LE. Respiratory cerebrospinal fluid flow is driven by the thoracic and lumbar spinal pressures. J Physiol 2020; 598:5789-5805. [PMID: 32990956 DOI: 10.1113/jp279458] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 09/22/2020] [Indexed: 01/20/2023] Open
Abstract
KEY POINTS Respiration plays a key role in the circulation of cerebrospinal fluid (CSF) around the central nervous system. During inspiration increased venous return from the cranium is believed to draw CSF rostrally. However, this mechanism does not explain why CSF has also been observed to move caudally during inspiration. We show that during inspiration decreased intrathoracic pressure draws venous blood from the cranium and lumbar spine towards the thorax. We also show that the abdominal pressure was associated with rostral CSF displacement. However, a caudal shift of cervical CSF was seen with low abdominal pressure and comparably negative intrathoracic pressures. These results suggest that the effects of epidural blood flow within the spinal canal need to be considered, as well as the cranial blood volume balance, to understand respiratory-related CSF flow. These results may prove useful for the treatment of CSF obstructive pathology and understanding the behaviour of intrathecal drug injections. ABSTRACT It is accepted that during inspiration, cerebrospinal fluid (CSF) flows rostrally to compensate for decreased cranial blood volume, caused by venous drainage due to negative intrathoracic pressure. However, this mechanism does not explain observations of caudal CSF displacement during inspiration. Determining the drivers of respiratory CSF flow is crucial for understanding the pathophysiology of CSF flow disorders. To quantify the influence of respiration on CSF flow, real-time phase-contrast magnetic resonance imaging (MRI) was used to record CSF and blood flow, while healthy subjects (5:5 M:F, 25-50 years) performed either a brief expiratory or inspiratory effort between breaths. Transverse images were taken perpendicular to the spinal canal in the middle of the C3 and L2 vertebrae. The same manoeuvres were then performed after a nasogastric pressure catheter was used to measure the intrathoracic and abdominal pressures. During expiratory-type manoeuvres that elevated abdominal and intrathoracic pressures, epidural blood flow into the spinal canal increased and CSF was displaced rostrally. With inspiratory manoeuvres, the negative intrathoracic pressure drew venous blood from C3 and L2 towards the thoracic spinal canal, and cervical CSF was displaced both rostrally and caudally, despite the increased venous drainage. Regression analysis showed that rostral displacement of CSF at both C3 (adjusted R2 = 0.53; P < 0.001) and L2 (adjusted R2 = 0.38; P < 0.001) were associated with the abdominal pressure. However, with low abdominal pressure and comparably negative intrathoracic pressure, cervical CSF flowed caudally. These findings suggest that changes in both the cranial and spinal pressures need to be considered to understand respiratory CSF flow.
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Affiliation(s)
- Robert A Lloyd
- Neuroscience Research Australia and Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Jane E Butler
- Neuroscience Research Australia and Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia and Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Iain K Ball
- Philips Australia & New Zealand, Sydney, NSW, Australia
| | - Barbara Toson
- Neuroscience Research Australia and Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Marcus A Stoodley
- Department of Clinical Medicine, Macquarie University, Sydney, NSW, Australia
| | - Lynne E Bilston
- Neuroscience Research Australia and Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
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Herbert RD, Taylor JL, Lord SR, Gandevia SC. Prevalence of motor impairment in residents of New South Wales, Australia aged 55 years and over: cross-sectional survey of the 45 and Up cohort. BMC Public Health 2020; 20:1353. [PMID: 32887600 PMCID: PMC7650517 DOI: 10.1186/s12889-020-09443-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The population prevalence of many diseases is known. However, little is known of the population prevalence of motor impairments. METHODS The aim of this study was to determine the point prevalence of specific motor impairments (weakness, fatigue, contracture, impaired balance and impaired coordination) in the population aged 55 years and older resident in New South Wales, Australia in 2018. 55,210 members of the 45 and Up cohort were invited to participate in a follow-up survey that included questions on motor impairment. Responses were received from 20,141 people (36%). Calibrated estimates of prevalence of specific motor impairments, and of having at least one motor impairment, were obtained using survey weights based on the known multivariate distributions of age, gender and geographical location (28 regions) in the population. RESULTS More than one-third of adults aged over 55 residing in New South Wales have difficulty using their hands, arms or legs. The prevalence of each motor impairment (muscle weakness, fatigue, contracture, impaired balance or impaired coordination) in this population is between 4 and 12%. The prevalence of at least one of these impairments is 21%. The prevalence of at least one impairment in people aged 85 and over is 42%. Women consistently had more difficulty using hands, arms and legs, and more motor impairment, than men. Difficulty using hands, arms and legs and the prevalence of all motor impairments, especially poor balance, greatly increased with age. CONCLUSION The prevalence of specific motor impairments in older Australian adults is high - comparable to that of the most prevalent diseases. There may be merit in considering motor impairment as a significant public health problem in its own right.
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Affiliation(s)
- R D Herbert
- Neuroscience Research Australia (NeuRA), Barker St, Randwick, NSW, 2031, Australia.
- University of New South Wales, Sydney, Australia.
| | - J L Taylor
- Neuroscience Research Australia (NeuRA), Barker St, Randwick, NSW, 2031, Australia
- Edith Cowan University, Perth, Australia
| | - S R Lord
- Neuroscience Research Australia (NeuRA), Barker St, Randwick, NSW, 2031, Australia
- University of New South Wales, Sydney, Australia
| | - S C Gandevia
- Neuroscience Research Australia (NeuRA), Barker St, Randwick, NSW, 2031, Australia
- University of New South Wales, Sydney, Australia
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Boswell-Ruys CL, Lewis C, McBain RA, Gandevia SC, Butler JE. The reliability of inspiratory resistive load magnitude and detection testing. Respir Physiol Neurobiol 2020; 281:103490. [PMID: 32712538 DOI: 10.1016/j.resp.2020.103490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/21/2020] [Accepted: 07/05/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To assess the test-retest reliability of inspiratory load detection and load magnitude perception tests in healthy volunteers. DESIGN Cohort of convenience. SETTING Respiratory physiology laboratory. PARTICIPANTS Twenty healthy adults. INTERVENTIONS On two separate occasions participants performed tests of inspiratory loading. Participants breathed through custom made resistive tubing and were asked to indicate when they detected a different resistance during inspiration. In a second test participants rated the magnitude of presented inspiratory loads using the modified Borg score. MAIN OUTCOME MEASURES Intra-class Correlation Coefficient (ICC2,1) values for repeated tests of inspiratory load detection threshold and load magnitude rating. RESULTS ICC2,1 values ranged from 0.657-0.786 for load detection testing and 0.739 to 0.969 for rating of load magnitude. CONCLUSIONS The tests are simple and reliable measures of inspiratory load detection and magnitude rating. They can be used in future research to determine the effectiveness of interventions to reduce the effort of breathing in health and disease.
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Affiliation(s)
- Claire L Boswell-Ruys
- Neuroscience Research Australia, Randwick, 2031, Australia; University of New South Wales, Sydney, 2052, Australia; Prince of Wales Hospital, Randwick, 2031, Australia.
| | - Chaminda Lewis
- Neuroscience Research Australia, Randwick, 2031, Australia; University of New South Wales, Sydney, 2052, Australia; Prince of Wales Hospital, Randwick, 2031, Australia
| | - Rachel A McBain
- Neuroscience Research Australia, Randwick, 2031, Australia; University of New South Wales, Sydney, 2052, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Randwick, 2031, Australia; University of New South Wales, Sydney, 2052, Australia; Prince of Wales Hospital, Randwick, 2031, Australia
| | - Jane E Butler
- Neuroscience Research Australia, Randwick, 2031, Australia; University of New South Wales, Sydney, 2052, Australia
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39
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Lin SD, Butler JE, Boswell-Ruys CL, Hoang PD, Jarvis T, Gandevia SC, McCaughey EJ. The effect of abdominal functional electrical stimulation on bowel function in multiple sclerosis: a cohort study. Mult Scler J Exp Transl Clin 2020; 6:2055217320941530. [PMID: 34691757 PMCID: PMC8529907 DOI: 10.1177/2055217320941530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 05/12/2020] [Accepted: 06/09/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Chronic constipation is prevalent in people with multiple sclerosis, with current treatments usually only partially effective. OBJECTIVES This study aims to evaluate the efficacy of abdominal functional electrical stimulation to reduce whole gut and colonic transit times and improve bowel and bladder-related quality of life. METHODS A total of 23 people with multiple sclerosis who fulfilled the Rome III criteria for functional constipation applied abdominal functional electrical stimulation for 1 hour per day, 5 days per week, for 6 weeks. Whole gut and colonic transit times and bowel and bladder-related quality of life were measured before and after the intervention period. RESULTS Whole gut (mean 81.3 (standard deviation 28.7) hours pre vs. 96.1 (standard deviation 53.6) hours post-intervention, P = 0.160) and colonic transit time (65.1 (31.4) vs. 74.8 (51.1) hours, P = 0.304) were unchanged following 6 weeks of abdominal functional electrical stimulation. There was a significant improvement in bowel (mean 1.78 (SD: 0.64) pre vs. 1.28 (SD: 0.54) post, P = 0.001) and bladder (50.6 (26.49) vs. 64.5 (21.92), p = 0.007) related quality of life after the intervention period. CONCLUSION While abdominal functional electrical stimulation did not reduce whole gut and colonic transit times for people with multiple sclerosis, a significant improvement in bowel and bladder-related quality of life was reported.
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Affiliation(s)
| | | | - Claire L Boswell-Ruys
- Neuroscience Research Australia, Australia
- School of Medical Sciences, University of New South Wales, Australia
| | - Phu D Hoang
- Neuroscience Research Australia, Australia
- School of Medical Sciences, University of New South Wales, Australia
- Continence Clinic, MS Limited, Australia
- Faculty of Health Sciences, Australian Catholic University, Australia
| | - Tom Jarvis
- Continence Clinic, MS Limited, Australia
- Prince of Wales Clinical School, University of New South Wales, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Australia
- School of Medical Sciences, University of New South Wales, Australia
- Prince of Wales Clinical School, University of New South Wales, Australia
| | - Euan J McCaughey
- Neuroscience Research Australia, Australia
- School of Medical Sciences, University of New South Wales, Australia
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40
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Luu BL, Saboisky JP, McBain RA, Trinder JA, White DP, Taylor JL, Gandevia SC, Butler JE. Genioglossus motor unit activity in supine and upright postures in obstructive sleep apnea. Sleep 2020; 43:5686881. [PMID: 31875918 DOI: 10.1093/sleep/zsz316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/03/2019] [Indexed: 11/14/2022] Open
Abstract
This study investigated whether a change in posture affected the activity of the upper-airway dilator muscle genioglossus in participants with and without obstructive sleep apnea (OSA). During wakefulness, a monopolar needle electrode was used to record single motor unit activity in genioglossus in supine and upright positions to alter the gravitational load that causes narrowing of the upper airway. Activity from 472 motor units was recorded during quiet breathing in 17 males, nine of whom had OSA. The mean number of motor units for each participant was 11.8 (SD 3.4) in the upright and 16.0 (SD 4.2) in the supine posture. For respiratory-modulated motor units, there were no significant differences in discharge frequencies between healthy controls and participants with OSA. Within each breath, genioglossus activity increased through the recruitment of phasic motor units and an increase in firing rate, with an overall increase of ~6 Hz (50%) across both postures and participant groups. However, the supine posture did not lead to compensatory increases in the peak discharge frequencies of inspiratory and expiratory motor units, despite the increase in gravitational load on the upper airway. Posture also had no significant effect on the discharge frequency of motor units that showed no respiratory modulation during quiet breathing. We postulate that, in wakefulness, any increase in genioglossus activity to compensate for the gravitational effects on the upper airway is achieved primarily through the recruitment of additional motor units in both healthy controls and participants with OSA.
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Affiliation(s)
- Billy L Luu
- Neuroscience Research Australia, Randwick, NSW, Australia
| | - Julian P Saboisky
- Neuroscience Research Australia, Randwick, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia
| | - Rachel A McBain
- Neuroscience Research Australia, Randwick, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia
| | | | - David P White
- Sleep Disorders Research Program, Division of Sleep Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Janet L Taylor
- Neuroscience Research Australia, Randwick, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia.,Edith Cowan University, Joondalup, WA, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Randwick, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia
| | - Jane E Butler
- Neuroscience Research Australia, Randwick, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia
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Abstract
It is generally accepted that proprioceptive ability deteriorates with age, although not all data support this view. We tested proprioception using three reliable tests at the ankle in 80 adults (19–80 yr). For all tests, the effects of muscle thixotropy were controlled. Under these conditions, we found no difference in proprioceptive acuity between young and old people.
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Affiliation(s)
| | - Simon C. Gandevia
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- Prince of Wales Hospital Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Janet L. Taylor
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- Edith Cowan University, Joondalup, Perth, Western Australia, Australia
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42
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D'Amico JM, Rouffet DM, Gandevia SC, Taylor JL. Unlike voluntary contractions, stimulated contractions of a hand muscle do not reduce voluntary activation or motoneuronal excitability. J Appl Physiol (1985) 2020; 128:1412-1422. [PMID: 32324475 DOI: 10.1152/japplphysiol.00553.2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Voluntary force declines during sustained, maximal voluntary contractions (MVC) due to changes in muscle and central nervous system properties. Central fatigue, an exercise-induced reduction in voluntary activation, is influenced by multiple processes. Some may occur independently of descending voluntary drive. To differentiate the effects associated with voluntary drive from other central and peripheral influences, we measured voluntary activation and motoneuron excitability following fatiguing contractions produced voluntarily or by electrical stimulation. On two separate days, participants performed either a 2-min MVC of adductor pollicis muscle or received 2-min continuous supramaximal electrical stimulation of the ulnar nerve. In study 1 (n = 14), the superimposed twitch elicited by ulnar nerve stimulation during brief MVCs was increased, and, hence, voluntary activation was reduced, up to 240 s after the 2-min MVC [-20 ± 12% (SD), P = 0.002] but not the 2-min stimulated contraction (-4 ± 7%), despite large reductions in MVC force (voluntary, -54 ± 18%; stimulated, -46 ± 16%). In study 2 (n = 12), F-waves recorded from the adductor pollicis were reduced in area for 150 s following the 2-min MVC (-21 ± 16%, P = 0.007) but not after the stimulated contraction (5 ± 27%). Therefore, voluntary activation and motoneuron excitability decreased only when descending voluntary drive was present during the fatiguing task. The findings do not exclude a cortical or brain stem contribution to the reduced voluntary activation but suggest that neither sensory feedback from the fatigued muscle nor repetitive activation of motoneurons underlie the changes, whereas they are consistent with motoneuronal inhibition by released factors linked to voluntary drive.NEW & NOTEWORTHY We demonstrate that reductions in voluntary activation and motoneuron excitability following 2-min isometric maximal contractions in humans occur only when fatigue is produced through voluntary contractions and not through electrically stimulated contractions. This is contrary to studies that suggest that changes in the superimposed twitch and therefore voluntary activation are explained by changes in peripheral factors alone. Thus, the interpolated twitch technique remains a viable tool to assess voluntary activation and central fatigue.
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Affiliation(s)
- J M D'Amico
- Neuroscience Research Australia, Randwick, New South Wales, Australia.,Kentucky Spinal Cord Injury Research Center, Department of Neurological Surgery, University of Louisville, Louisville, Kentucky
| | - D M Rouffet
- Kentucky Spinal Cord Injury Research Center, Department of Health and Sport Sciences, University of Louisville, Louisville, Kentucky.,Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
| | - S C Gandevia
- Neuroscience Research Australia, Randwick, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - J L Taylor
- Neuroscience Research Australia, Randwick, New South Wales, Australia.,School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
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43
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Boswell-Ruys CL, Lewis CRH, Wijeysuriya NS, McBain RA, Lee BB, McKenzie DK, Gandevia SC, Butler JE. Impact of respiratory muscle training on respiratory muscle strength, respiratory function and quality of life in individuals with tetraplegia: a randomised clinical trial. Thorax 2020; 75:279-288. [PMID: 31937553 DOI: 10.1136/thoraxjnl-2019-213917] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 12/05/2019] [Accepted: 12/08/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Respiratory complications remain a leading cause of morbidity and mortality in people with acute and chronic tetraplegia. Respiratory muscle weakness following spinal cord injury-induced tetraplegia impairs lung function and the ability to cough. In particular, inspiratory muscle strength has been identified as the best predictor of the likelihood of developing pneumonia in individuals with tetraplegia. We hypothesised that 6 weeks of progressive respiratory muscle training (RMT) increases respiratory muscle strength with improvements in lung function, quality of life and respiratory health. METHODS Sixty-two adults with tetraplegia participated in a double-blind randomised controlled trial. Active or sham RMT was performed twice daily for 6 weeks. Inspiratory muscle strength, measured as maximal inspiratory pressure (PImax) was the primary outcome. Secondary outcomes included lung function, quality of life and respiratory health. Between-group comparisons were obtained with linear models adjusting for baseline values of the outcomes. RESULTS After 6 weeks, there was a greater improvement in PImax in the active group than in the sham group (mean difference 11.5 cmH2O (95% CI 5.6 to 17.4), p<0.001) and respiratory symptoms were reduced (St George Respiratory Questionnaire mean difference 10.3 points (0.01-20.65), p=0.046). Significant improvements were observed in quality of life (EuroQol-Five Dimensional Visual Analogue Scale 14.9 points (1.9-27.9), p=0.023) and perceived breathlessness (Borg score 0.64 (0.11-1.17), p=0.021). There were no significant improvements in other measures of respiratory function (p=0.126-0.979). CONCLUSIONS Progressive RMT increases inspiratory muscle strength in people with tetraplegia, by a magnitude which is likely to be clinically significant. Measurement of baseline PImax and provision of RMT to at-risk individuals may reduce respiratory complications after tetraplegia. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN 12612000929808).
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Affiliation(s)
- Claire L Boswell-Ruys
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- Prince of Wales Hospital and Community Health Services, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Chaminda R H Lewis
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- Prince of Wales Hospital and Community Health Services, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | | | - Rachel A McBain
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Bonsan Bonne Lee
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- Prince of Wales Hospital and Community Health Services, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - David K McKenzie
- Prince of Wales Hospital and Community Health Services, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- Prince of Wales Hospital and Community Health Services, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Jane E Butler
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
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44
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Nguyen DAT, Lewis RHC, Boswell-Ruys CL, Hudson AL, Gandevia SC, Butler JE. Increased diaphragm motor unit discharge frequencies during quiet breathing in people with chronic tetraplegia. J Physiol 2020; 598:2243-2256. [PMID: 32083718 DOI: 10.1113/jp279220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 02/18/2020] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Respiratory muscle strength is compromised in people with tetraplegia, which may be compensated for by an increase in neural drive to the diaphragm. We found that the discharge frequencies of diaphragm motor units are higher in people with chronic tetraplegia compared with able-bodied people during quiet breathing. Furthermore, we found that the area of single motor unit potentials was increased in people with tetraplegia. These results suggest an increased motoneurone output to the diaphragm and remodelling of diaphragm motor units to maintain ventilation in tetraplegia. ABSTRACT People with tetraplegia have reduced inspiratory muscle strength, ∼40% of able-bodied individuals. Paralysed or partially paralysed respiratory muscles as a result of tetraplegia compromise lung function, increase the incidence of respiratory infections and can cause dyspnoea. We hypothesised that reduced inspiratory muscle strength in tetraplegia may increase neural drive to the inspiratory muscles to maintain ventilation. We recorded the discharge properties of single motor units from the diaphragm in participants with chronic tetraplegia (8 males, 42-78 years, C3-C6 injury, AIS A-C) and able-bodied control participants (6 males matched for age and body mass index). In each group, 117 and 166 single motor units, respectively, were discriminated from recordings in the costal diaphragm using a monopolar electrode. A linear mixed-effects model analysis showed higher peak discharge frequencies of motor units during quiet breathing in tetraplegia (17.8 ± 4.9 Hz; mean ± SD) compared with controls (12.4 ± 2.2 Hz) (P < 0.001). There were no differences in tidal volume, inspiratory time or mean air flow between groups. Motor unit potentials in tetraplegia, compared with controls, were larger in amplitude (1.1 ± 0.7 mV and 0.5 ± 0.3 mV, respectively, P = 0.007) and area (1.83 ± 1.49 µV ms and 0.69 ± 0.52 µV ms, respectively, P = 0.003). The findings indicate that diaphragm motor unit remodelling is likely to have occurred in people with chronic tetraplegia and that there is an increase in diaphragm motor unit discharge rates during quiet breathing. These neural changes ensure that ventilation is maintained in people with chronic tetraplegia.
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Affiliation(s)
- D A T Nguyen
- Neuroscience Research Australia.,University of New South Wales
| | - R H C Lewis
- Neuroscience Research Australia.,University of New South Wales.,Prince of Wales Hospital, NSW, Australia
| | - C L Boswell-Ruys
- Neuroscience Research Australia.,University of New South Wales.,Prince of Wales Hospital, NSW, Australia
| | - A L Hudson
- Neuroscience Research Australia.,University of New South Wales
| | - S C Gandevia
- Neuroscience Research Australia.,University of New South Wales.,Prince of Wales Hospital, NSW, Australia
| | - Jane E Butler
- Neuroscience Research Australia.,University of New South Wales
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45
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Chen LW, Glinsky JV, Islam MS, Hossain M, Boswell-Ruys CL, Kataria C, Redhead J, Xiong Y, Gollan E, Costa PD, Denis S, Ben M, Chaudhary L, Wang J, Hasnat MAK, Yeomans J, Gandevia SC, Harvey LA. The effects of 10,000 voluntary contractions over 8 weeks on the strength of very weak muscles in people with spinal cord injury: a randomised controlled trial. Spinal Cord 2020; 58:857-864. [PMID: 32086442 PMCID: PMC7402990 DOI: 10.1038/s41393-020-0439-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 01/27/2020] [Accepted: 02/04/2020] [Indexed: 01/30/2023]
Abstract
Study design A multi-centred, single-blinded randomised controlled trial. Objectives To determine the effect of 10,000 voluntary contractions over 8 weeks on the strength of very weak muscles in people with spinal cord injury (SCI). Settings Seven hospitals in Australia and Asia. Methods One hundred and twenty people with recent SCI undergoing inpatient rehabilitation were randomised to either a Treatment or Control Group. One major muscle group from an upper or lower limb was selected if the muscle had grade 1 or grade 2 strength on a standard six-point manual muscle test. Participants allocated to the Treatment Group performed 10,000 isolated contractions of the selected muscle group, as well as usual care in 48 sessions over 8 weeks. Participants allocated to the Control Group received usual care alone. Participants were assessed at baseline and 8 weeks by a blinded assessor. The primary outcome was voluntary muscle strength on a 13-point manual muscle test. There were three secondary outcomes capturing therapists’ and participants’ perceptions of strength and function. Results The mean between-group difference of voluntary strength at 8 weeks was 0.4/13 points (95% confidence interval −0.5 to 1.4) in favour of the Treatment Group. There were no notable between-group differences on any secondary outcome. Conclusion Ten thousand isolated contractions of very weak muscles in people with SCI over 8 weeks has either no or a very small effect on voluntary strength.
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Affiliation(s)
- Lydia W Chen
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health Sciences, University of Sydney, St Leonards, NSW, Australia.,Spinal Injuries Unit, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Joanne V Glinsky
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health Sciences, University of Sydney, St Leonards, NSW, Australia
| | - Md Shofiqul Islam
- Centre for the Rehabilitation of the Paralysed, Savar, Dhaka, Bangladesh
| | - Muzaffor Hossain
- Centre for the Rehabilitation of the Paralysed, Savar, Dhaka, Bangladesh
| | - Claire L Boswell-Ruys
- Spinal Injuries Unit, Prince of Wales Hospital, Randwick, NSW, Australia.,Neuroscience Research Australia (NeuRA), University of New South Wales, Randwick, NSW, Australia
| | - Chitra Kataria
- Indian Spinal Injuries Centre, Sector-C, Vasant Kunj, Delhi, India
| | - Jason Redhead
- Spinal Injuries Unit, Royal Rehab, Ryde, NSW, Australia
| | - Yuan Xiong
- Guangdong Work Injury Rehabilitation Hospital, Guangdong, China
| | - Emilie Gollan
- Queensland Spinal Cord Injuries Service, Metro South Health, Brisbane, QLD, Australia
| | - Punam D Costa
- Centre for the Rehabilitation of the Paralysed, Savar, Dhaka, Bangladesh
| | - Sophie Denis
- Spinal Injuries Unit, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Marsha Ben
- NSW Spinal Outreach Service, Ryde, NSW, Australia
| | - Lovely Chaudhary
- Indian Spinal Injuries Centre, Sector-C, Vasant Kunj, Delhi, India
| | - Jun Wang
- Guangdong Work Injury Rehabilitation Hospital, Guangdong, China
| | | | - Jayne Yeomans
- Spinal Injuries Unit, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia (NeuRA), University of New South Wales, Randwick, NSW, Australia
| | - Lisa A Harvey
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health Sciences, University of Sydney, St Leonards, NSW, Australia.
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Nguyen DAT, Boswell-Ruys CL, McCaughey EJ, Gandevia SC, Hudson AL, Butler JE. Absence of inspiratory premotor potentials during quiet breathing in cervical spinal cord injury. J Appl Physiol (1985) 2020; 128:660-666. [PMID: 32078470 DOI: 10.1152/japplphysiol.00831.2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
A premotor potential, or Bereitschaftspotential (BP), is a low-amplitude negativity in the electroencephalographic activity (EEG) of the sensorimotor cortex. It begins ~1 s prior to the onset of inspiration in the averaged EEG. Although normally absent during quiet breathing in healthy, younger people, inspiration-related BPs are present in people with respiratory disease and healthy, older people, indicating a cortical contribution to quiet breathing. People with tetraplegia have weak respiratory muscles and increased neural drive during quiet breathing, indicated by increased inspiratory muscle activity. Therefore, we hypothesized that BPs would be present during quiet breathing in people with tetraplegia. EEG was recorded in 17 people with chronic tetraplegia (14M, 3 female; 22-51 yr; C3-C7, American Spinal Injury Association Impairment Scale A-D; >1 yr postinjury). They had reduced lung function and respiratory muscle weakness [FEV1: 54 ± 19% predicted, FVC: 59 ± 22% predicted and MIP: 56 ± 24% predicted (mean ± SD)]. Participants performed quiet breathing and voluntary self-paced sniffs (positive control condition). A minimum of 250 EEG epochs during quiet breathing and 60 epochs during sniffs, time-locked to the onset of inspiration, were averaged to determine the presence of BPs at Cz, FCz, C3, and C4. Fifteen participants (88%) had a BP for the sniffs. Of these 15 participants, only one (7%) had a BP in quiet breathing, a rate similar to that reported during quiet breathing in young able-bodied participants (12%). The findings suggest that, as in young able-bodied people, a cortical contribution to quiet breathing is absent in people with tetraplegia despite higher neural drive.NEW & NOTEWORTHY People with tetraplegia have weak respiratory muscles, increased neural drive during quiet breathing, and a high incidence of sleep-disordered breathing. Using electroencephalographic recordings, we show that inspiratory premotor potentials are absent in people with chronic tetraplegia during quiet breathing. This suggests that cortical activity is not present during resting ventilation in people with tetraplegia who are awake and breathing independently.
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Affiliation(s)
- David A T Nguyen
- Neuroscience Research Australia, New South Wales, Australia.,University of New South Wales, New South Wales, Australia
| | - Claire L Boswell-Ruys
- Neuroscience Research Australia, New South Wales, Australia.,University of New South Wales, New South Wales, Australia.,Prince of Wales Hospital, New South Wales, Australia
| | - Euan James McCaughey
- Neuroscience Research Australia, New South Wales, Australia.,University of New South Wales, New South Wales, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, New South Wales, Australia.,University of New South Wales, New South Wales, Australia.,Prince of Wales Hospital, New South Wales, Australia
| | - Anna L Hudson
- Neuroscience Research Australia, New South Wales, Australia.,University of New South Wales, New South Wales, Australia
| | - Jane E Butler
- Neuroscience Research Australia, New South Wales, Australia.,University of New South Wales, New South Wales, Australia.,Prince of Wales Hospital, New South Wales, Australia
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Jugé L, Knapman FL, Burke PG, Brown E, Bosquillon de Frescheville AF, Gandevia SC, Eckert DJ, Butler JE, Bilston LE. Regional respiratory movement of the tongue is coordinated during wakefulness and is larger in severe obstructive sleep apnoea. J Physiol 2020; 598:581-597. [DOI: 10.1113/jp278769] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 12/02/2019] [Indexed: 12/12/2022] Open
Affiliation(s)
- Lauriane Jugé
- Neuroscience Research Australia Sydney New South Wales Australia
- School of Medical Sciences University of New South Wales Sydney New South Wales Australia
| | - Fiona L. Knapman
- Neuroscience Research Australia Sydney New South Wales Australia
- Prince of Wales Clinical School University of New South Wales Sydney New South Wales Australia
| | - Peter G.R. Burke
- Neuroscience Research Australia Sydney New South Wales Australia
- School of Medical Sciences University of New South Wales Sydney New South Wales Australia
- Biomedical Sciences Department Administration Macquarie University Sydney New South Wales Australia
| | - Elizabeth Brown
- Neuroscience Research Australia Sydney New South Wales Australia
- Prince of Wales Hospital Sydney New South Wales Australia
| | | | - Simon C. Gandevia
- Neuroscience Research Australia Sydney New South Wales Australia
- Prince of Wales Clinical School University of New South Wales Sydney New South Wales Australia
| | - Danny J. Eckert
- Neuroscience Research Australia Sydney New South Wales Australia
- School of Medical Sciences University of New South Wales Sydney New South Wales Australia
- Adelaide Institute for Sleep Health Flinders University Adelaide Australia
| | - Jane E. Butler
- Neuroscience Research Australia Sydney New South Wales Australia
- School of Medical Sciences University of New South Wales Sydney New South Wales Australia
| | - Lynne E. Bilston
- Neuroscience Research Australia Sydney New South Wales Australia
- Prince of Wales Clinical School University of New South Wales Sydney New South Wales Australia
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Osman AM, Carberry JC, Gandevia SC, Butler JE, Eckert DJ. Changes in pharyngeal collapsibility and genioglossus reflex responses to negative pressure during the respiratory cycle in obstructive sleep apnoea. J Physiol 2020; 598:567-580. [DOI: 10.1113/jp278433] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 11/11/2019] [Indexed: 11/08/2022] Open
Affiliation(s)
- Amal M. Osman
- Neuroscience Research Australia (NeuRA) Sydney NSW Australia
- School of Medical Sciences University of New South Wales Sydney NSW Australia
- Flinders University Adelaide Institute for Sleep Health Bedford Park SA Australia
- CRC for Alertness Safety and Productivity Melbourne Australia
| | - Jayne C. Carberry
- Neuroscience Research Australia (NeuRA) Sydney NSW Australia
- School of Medical Sciences University of New South Wales Sydney NSW Australia
- Flinders University Adelaide Institute for Sleep Health Bedford Park SA Australia
| | - Simon C. Gandevia
- Neuroscience Research Australia (NeuRA) Sydney NSW Australia
- School of Medical Sciences University of New South Wales Sydney NSW Australia
| | - Jane E. Butler
- Neuroscience Research Australia (NeuRA) Sydney NSW Australia
- School of Medical Sciences University of New South Wales Sydney NSW Australia
| | - Danny J. Eckert
- Neuroscience Research Australia (NeuRA) Sydney NSW Australia
- School of Medical Sciences University of New South Wales Sydney NSW Australia
- Flinders University Adelaide Institute for Sleep Health Bedford Park SA Australia
- CRC for Alertness Safety and Productivity Melbourne Australia
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49
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McCaughey EJ, Butler JE, McBain RA, Boswell-Ruys CL, Hudson AL, Gandevia SC, Lee BB. Abdominal Functional Electrical Stimulation to Augment Respiratory Function in Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2019; 25:105-111. [PMID: 31068742 DOI: 10.1310/sci2502-105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Functional electrical stimulation (FES) is the application of electrical pulses to a nerve to achieve a functional muscle contraction. Surface electrical stimulation of the nerves that innervate the abdominal muscles, termed abdominal FES, can cause the abdominal muscles to contract, even when paralysed after spinal cord injury. As the abdominal muscles are the major expiratory muscles, and commonly partially or completely paralysed in tetraplegia, abdominal FES offers a promising method of improving respiratory function for this patient group. Objective: The aim of the article is to provide readers with a better understanding of how abdominal FES can be used to improve the health of the spinal cord-injured population. Methods: A narrative review of the abdominal FES literature was performed. Results: Abdominal FES can achieve an immediate effective cough in patients with tetraplegia, while the repeated application over 6 weeks of abdominal FES can improve unassisted respiratory function. Ventilator duration and tracheostomy cannulation time can also be reduced with repeated abdominal FES. Conclusion: Abdominal FES is a noninvasive method to achieve functional improvements in cough and respiratory function in acute and chronically injured people with tetraplegia. Potential practical outcomes of this include reduced ventilation duration, assisted tracheostomy decannulation, and a reduction in respiratory complications. All of these outcomes can contribute to reduced morbidity and mortality, improved quality of life, and significant potential cost savings for local health care providers.
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Affiliation(s)
- E J McCaughey
- Neuroscience Research Australia, Randwick, Australia.,School of Medical Sciences, University of New South Wales, Kensington, Australia
| | - J E Butler
- Neuroscience Research Australia, Randwick, Australia.,School of Medical Sciences, University of New South Wales, Kensington, Australia
| | - R A McBain
- Neuroscience Research Australia, Randwick, Australia.,School of Medical Sciences, University of New South Wales, Kensington, Australia.,Prince of Wales Hospital, Randwick, Australia
| | - C L Boswell-Ruys
- Neuroscience Research Australia, Randwick, Australia.,School of Medical Sciences, University of New South Wales, Kensington, Australia.,Prince of Wales Hospital, Randwick, Australia
| | - A L Hudson
- Neuroscience Research Australia, Randwick, Australia.,School of Medical Sciences, University of New South Wales, Kensington, Australia
| | - S C Gandevia
- Neuroscience Research Australia, Randwick, Australia.,School of Medical Sciences, University of New South Wales, Kensington, Australia.,Prince of Wales Hospital, Randwick, Australia
| | - B B Lee
- Neuroscience Research Australia, Randwick, Australia.,School of Medical Sciences, University of New South Wales, Kensington, Australia.,Prince of Wales Hospital, Randwick, Australia
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50
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Hudson AL, Walsh LD, Gandevia SC, Butler JE. Respiratory muscle activity in voluntary breathing tracking tasks: Implications for the assessment of respiratory motor control. Respir Physiol Neurobiol 2019; 274:103353. [PMID: 31760130 DOI: 10.1016/j.resp.2019.103353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/24/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
Abstract
How the involuntary (bulbospinal) and voluntary (corticospinal) pathways interact in respiratory muscle control is not established. To determine the role of excitatory corticobulbar pathways in humans, studies typically compare electromyographic activity (EMG) or evoked responses in respiratory muscles during hypercapnic and voluntary tasks. Although ventilation is matched between tasks by having participants track signals of ventilation, these tasks may not result in matched respiratory muscle activity. The aim of this study was to describe respiratory muscle activity and ribcage and abdominal excursions during two different voluntary conditions, compared to hypercapnic hyperventilation. Ventilation was matched in the voluntary conditions via (i) a simple target of lung volume ('volume tracking') or (ii) targets of both ribcage and abdominal excursions, adjusted to end-expiratory lung volume in hypercapnic hyperventilation ('bands tracking'). Compared to hypercapnic hyperventilation, respiratory parameters such as tidal volume were similar, but the ratio of ribcage to abdominal excursion was higher for both voluntary tasks. Inspiratory scalene and parasternal intercostal muscle activity was higher in volume tracking, but diaphragm and abdominal muscle activity showed little to no change. There were no differences in muscle activity in bands tracking for any muscle, compared to hypercapnic hyperventilation. An elevated ratio of ribcage to abdominal excursion in the bands tracking task indicates that participants could not accurately match the targets in this condition. Inspiratory muscle activity is altered in some muscles in some voluntary tasks, compared to hypercapnia. Therefore, differences in muscle activity should be considered in interpretation of studies that use these protocols to investigate respiratory muscle control.
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Affiliation(s)
- Anna L Hudson
- Neuroscience Research Australia and University of New South Wales, Sydney, Australia.
| | - Lee D Walsh
- Neuroscience Research Australia and University of New South Wales, Sydney, Australia; Platypus Technical Consultants Pty Ltd, Canberra, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia and University of New South Wales, Sydney, Australia
| | - Jane E Butler
- Neuroscience Research Australia and University of New South Wales, Sydney, Australia
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